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PNC Healthcare Winning Under Reform: Strategies to Optimize the Revenue Cycle December 13, 2011
PNC Healthcare
Winning Under Reform: Strategies to Optimize
the Revenue Cycle
December 13, 2011
2
Today’s Presentation Goals
• Economics of U.S. Healthcare
• Overview of Healthcare Reform
– Timeline & Provisions
• Revenue Cycle Optimization
• What to Do Now?
• Q&A
3
U.S. HEALTHCARE ECONOMICS
4
U.S. Healthcare Expenditures per Capita
$0
$1,000
$2,000
$3,000
$4,000
$5,000
$6,000
$7,000
$8,000
Source: Organization for Economic Co-operation and Development (OECD) Statistics
5
U.S. Healthcare Share of GDP
2007Source: Centers for Medicare and Medicaid Services, Office of the Actuary, National Health Statistics Group, at http://www.cms.hhs.gov/NationalHealthExpendData/
(see Historical; NHE summary including share of GDP, CY 1960-2007; file nhegdp07.zip).
6
Other Sectors84%
Health Care Expenditures,
16.2%
Other, 32%
Nursing Home Care, 6%
Prescription Drugs, 10%
Physician Services, 21%
Hospital Care, 31%
U.S. GDP 2008 $2.34 Trillion
Hospitals Account for Almost One-Third of Health Care Expenditures
Source: CMS, Office of the Actuary. Data released January 5, 2010.
National Health Expenditures as a Percentage of GDP and Breakdown of National Health Expenditures in 2008
7
0%
2%
4%
6%
8%
10%
12%
14%
16%
18%
1900 1910 1920 1930 1940 1950 1960 1970 1980 1990 1995 2000 2006
Prefabricated Bandages Sutures
Kidney dialysis
Open-heart Surgery
Pacers
Balloon angioplasty
Stents
Insulin pumps
Biventricular pacing
Hips and knees
MRIs
ICDs
Less-invasive surgery
Neuro
Drug-eluting stents
Source: % GDP Data From Centers for Medicare & Medicaid Services, Office of the Actuary. Data released January 7, 2008.
Healt
hcare
Sp
en
din
g a
s a
% o
f G
DP
Introduction of Medical Devices and Rise of Healthcare Spending
8
And the Issue of Uncompensated Care Cost to Hospitals
Source: American Hospital Association, Uncompensated Hospital Care Cost Fact Sheet, (Nov 2009)
4.5%
5.0%
5.5%
6.0%
6.5%
0
5
10
15
20
25
30
35
40
% o
f To
tal
Exp
en
ses
$ B
illio
ns
Cost % of Total
9
Uninsured by State – Florida, Texas, Louisiana and New Mexico Have the Highest Uninsured Rates
Average Percent Uninsured by State, 2006 – 2008 16% of the population is uninsured
< 10.0%
10.0% - 14.9%
15.0% - 19.9%
20.0%
RI 10.4%
DE 11.4%
DC 10.4%
Source: US Census Bureau, Income, Poverty, and Health Insurance Coverage in the United States: 2008. Data released August 2009.
9
10
Hospitals Already Face Public Underfunding
Hospital Payment Shortfall Relative to Costs 1997-2008
Source: Avalere Health analysis of American Hospital Association Annual Survey data, 2008, for community hospitals.
10
-$35
-$30
-$25
-$20
-$15
-$10
-$5
$0
$5
97 98 99 00 01 02 03 04 05 06 07 08
Bill
ions
Medicare
Medicaid
Other Government
11
Source: CMS
$0
$500
$1,000
$1,500
$2,000
$2,500
$3,000
$3,500
$4,000
$4,500
2002 2006 2017*
$671 $879
$1,734$721
$970
$2,079
$211
$257
$464
$ B
illio
ns
National Health Expenditure ($ Billions)
Out of Pocket
Public Funds
Insurance Funds13%
45%
42%
12%
46%
42%
11%
49%
40%*Projected
While the Percent of Healthcare Expenditures Funded by Public Funds is Increasing
12
Source: USA Today
49.2
36.830.3
19.113.7
10.6
2.4
64.5
51.246.7
26.921.0
17.2
3.1
0
10
20
30
40
50
60
70
Pulmonary Conditions
Hypertension Mental Disorders
Heart Disease Diabetes Cancers Stroke
2003 Cases (Millions) 2023 Projected Total Cases (Millions)
Not to Mention the Projected Growth in Chronic Diseases
13
Source: USA Today
$1,047
$3,363 $277
$790
$-
$1,000
$2,000
$3,000
$4,000
$5,000
2003 2023
Cost of the Seven Most Common Chronic Diseases in Treatment and Lost Economic Input ($$$Billions):
Lost Output Treatment
Future Impact of Chronic Diseases
14
Hospitals with Negative Profit Margins
Source: HFMA Revenue Cycle Strategist/Thomson Reuters Action OI database
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
Q2 2009 Q3 2009 Q4 2009 Q1 2010 Q2 2010
All Hospitals Small Community Medium Community
Large Community Teaching Major Teaching
15
While trying to Rise to the Challenge of New Healthcare Standards
• Providers and Payers must deal with the burden of information technology mandates
– Implementation of 5010
– Electronic health record implementation and “meaningful use”
– Recovery Audit Contractors, other audits
– Demand for transparency
– New standards for providing EOBs
– Required reporting of proportion of dollars spent on: clinical services, quality and other costs and provide rebates to consumers (medical debt ratio)
– Pay for Performance, “Never Events”, bundled payments…
– New standards for financial and administrative transactions to promote administrative simplification
16
20 percent of all claims submitted in an
average month are delayed or denied
On average, providers must submit claims
four times to get paid
Two-thirds of providers need to resubmit a
claim two or more times
Nearly three-quarters of payers have to
interact with providers at least three times
to obtain all the necessary information to
pay
Remittances frequently still posted from
paper EOBs, making consistent capture of
denial data and use of reason codes highly
variable and creating denial management
challenges
Efficiency – Both Payer and Provider
17
Preparation for 5010
• PNC client survey conducted August, 2010 to gain understanding of their migration process
– 55% of provider clients and 20% of payer clients responded
– 55% of providers were prepared to test during Q1 2011 versus 35% of payers
– Majority of payers will be capable of dual processing (processing claims from providers who have not converted from 4010 and those who have migrated to 5010)
– 79% of providers plan to implement 5010 format on an individual transaction basis. For example, provider would best 835 transaction first and implement 5010 format of 835 immediately following successful testing
• A large part of the work effort and cost for 5010 migration is in testing through end-to-end processing, requiring significant time and leadership commitment
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Bottom Line! Current Hospital Revenue Cycle Environment
• Huge fragmentation
o More than 2,000 payers
o 30,000 contact points - or "channels“ to deal with
• Cumbersome processes
• Unenforceable standards – HIPAA standardization
• Excessive reliance on paper or proprietary gateways
• Constantly changing payment protocols
• Abnormally high and accelerating costs of billing and collections for healthcare encounters
• Reimbursement and market pressures continue to reduce share of resources available for overburdened and understaffed administrative functions
The end result? A Lot of Administrative Waste.
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HEALTHCARE REFORM
20 20
A New World
• Reform signed into law March 30, 2010
• Sweeping changes to healthcare
• Final bill NOT the final word… full or partial repeal? Revision?
• Implemented over the next five years in the following areas:
– Expanded coverage
– Medicare payment cuts
– Payments tied to quality
– Delivery system reforms
– National evidence-based
quality strategy
– Attack fraud and abuse
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The Reform Environment
1. Managing to Medicare
Clinical Care Delivery
Transformation
WASTE
Workflow and Labor
Non-Labor
Resource Utilization
Revenue Enhancement
Physician Alignment
2. ACO Assessment and
Implementation
Assessment
Implementation
Assure cost position is
aligned with revenue
profile
Collaborate with
physicians to improve
quality & lower costs
Become an accountable
delivery system
Provisions Implications Solutions
Transform the delivery of
care (variability &
resources)
1. Cuts to Existing FFS
System
• Across the board payment
cuts
• Value-based purchasing
• Non-payment for
preventable readmissions
• Non-payment for infections
and HACs
2. Disruption of Existing
System
• Bundled payments
• Accountable Care
Organizations
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Changes of Healthcare Reform
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Payment Cuts in Healthcare Reform
• Nearly $200 billion in Medicare reimbursement cuts over 10 years.
• Combined, payment cuts to hospitals could amount to 15% of total inpatient Medicare reimbursement.
• Independent Payment Advisory Board to recommend cost reductions starting in 2020
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24
Year Penalty / Individual
2014 $95
2015 $325
2016 $695
• 133% of Federal Poverty Level (FPL)
• Non-pregnant, childless adults
• 100% federal match for first 2 years,
then scales back
$2,000 per FTE penalty
• Subsidies range (133% - 400% of
FPL)
• Essential benefits mandated
Individual Mandate Employer Play or Pay
Medicaid Expansion Insurance Subsidies through State
Exchanges
Coverage Provisions
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48%
32%
1%
7%
7%6%
HR 3200As Amended by Energy and
Commerce Committee
Employer Sponsored (Non-
Exchange)
Medicare, Medicaid, & Other
Public Programs
Individual Enrollment in
Private Plans
Health Insurance Exchanges: Private
Plans
Health Insurance Exchanges: Public
Plans
Remaining Uninsured
Enhancing Coverage
* Source: Peter G. Peterson Foundation analysis based on The Lewin Group, Long –Term Cost of the American Affordable Health Choices Act of 2009, as amended.
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Revenue Cycle – the Tip of the Iceberg
Balanced Budget Act/HIPAA
Billing and Collections Improvement
Pricing Transparency
Compliance Audit Recovery (RAC/MIC/MAC)
Payment Cuts & Cost Shifting
P4P Provisions & Poor Performance Penalties
Geographic Payment Adjustment Provisions
Transparency Provisions
Coverage Expansion Provisions
Delivery System Provisions
7-10% net revenue
2-3% net revenue
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The “Pillars of Success” in the Era of Reform Optimizing Revenue Cycle Performance
Address the Value
Equation
Clinical Excellence
Service Excellence
Operational Effectiveness
At the lowest cost position
Align with Physicians
Medical Staff Education
Physician lead PI teams to address
VBP
Clinical Integration via employment &
virtual models
EMR Implementation
Transform the System
of Care Care continuum – including pre- and
post- hospital
Reduce readmissions &
HACs
Lower LOS
Reduce variability & resource
consumption
Optimize Revenue
Service portfolio & market share improvement
Revenue cycle
Accountable Delivery Organization
Move from transaction-oriented to outcome-
oriented
Become “accountable” for outcomes and costs for a
population
Partner with providers to coordinate episodes of
care
Pricing strategy
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REVENUE CYCLE OPTIMIZATION
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Patient Access
Scheduling/ Pre-registration
Ins. Verification/ Authorization
POS Collections
Financial Counseling
Registration
Revenue Integrity
Charge Capture
Clinical Documentation
Chargemaster Management
Coding
HIM Throughput
Claims Management
Billing
AR Follow-up & Management
Payment Posting
Customer Service
Collections/ Agency Management
Reimbursement
3rd Party Contracting
Denials Management
Contract Management
Pricing Strategy/ Fee Schedules
Revenue Recognition
Revenue Cycle Management – Our View
Pre-Service Time-of-Service
Discharged-Not-Final-
Billed Final Billed Collections
Final Payment
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Revenue Cycle Optimization
1. Understand & Model Reform Impacts – Payment Cuts & Cost Shifting
– P4P Provisions & Poor Performance Penalties
– Geographic Payment Adjustment Provisions
– Transparency Provisions
– Coverage Expansion Provisions
– Delivery System Provisions
2. Optimize current processes – Continuously benchmark and diagnose performance
3. Focus on the Pre-Service Model – Pre-Registration, Eligibility/Insurance Verification, Patient
Payment Estimation
4. Integration of Technology – Use technology to improve efficiency
– Automate repetitive tasks
– Bend the cost curve
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Revenue Cycle Optimization Model Reform Impact
NCH Healthcare System, Naples, FL
IMPACT ON IPPS MEDICARE PAYMENTS OF SELECTED PROVISIONS OF THE
AFFORDABLE CARE ACT (ACA)
2010 2011 2019 2010-2019
ESTIMATED MEDICARE PAYMENTS UNDER PRIOR LAW $140,562,071 $143,373,313 $172,651,464 $1,558,035,312
Market Basket Update Reduction ($245,428) ($601,128) ($21,465,918) ($89,154,825)
Reduction of DSH Operating Payments ($4,319,887) ($25,620,835)
Additional Payments for Uncompensated Care Costs $2,625,695 $15,707,117
Readmissions Reduction Amount (AMI, HF, Pneumonia) $0 $0
Readmissions Reduction Amount (COPD, CABG, PTCA, OVC) #N/A #N/A
Reduction for High Rate of Hospital Acquired Conditions $0 $0
Value Based Purchasing Net Impact ($987,605) ($5,608,207)
ESTIMATED TOTAL IPPS IMPACT ($245,428) ($601,128) ($24,147,714) ($104,676,749)
Percent Change from Prior Law -0.17% -0.42% -13.99% -6.72%
ESTIMATED IPPS PAYMENTS UNDER PPACA $140,316,643 $142,772,184 $148,503,750 $1,453,358,563
2010 2011 2019 2010-2019
Expansion of Insurance Coverage (Optional Provider Estimate) $313,000 $9,880,300 $45,492,000
Percent Change from Prior Law 2.92%
COMBINED IMPACT OF IPPS CHANGES AND EXPANSION ($245,428) ($601,128) ($14,267,414) ($59,184,749)
Percent Change from Prior Law -0.17% -0.42% -8.26% -3.80%
ESTIMATED TOTAL IPPS AND EXPANSION PAYMENTS $140,316,643 $142,772,184 $158,384,050 $1,498,850,563
NCH Healthcare System, Naples, FL
IMPACT ON IPPS MEDICARE PAYMENTS OF SELECTED PROVISIONS OF THE
AFFORDABLE CARE ACT (ACA)
2010 2011 2019 2010-2019
ESTIMATED MEDICARE PAYMENTS UNDER PRIOR LAW $140,562,071 $143,373,313 $172,651,464 $1,558,035,312
Market Basket Update Reduction ($245,428) ($601,128) ($21,465,918) ($89,154,825)
Reduction of DSH Operating Payments ($4,319,887) ($25,620,835)
Additional Payments for Uncompensated Care Costs $2,625,695 $15,707,117
Readmissions Reduction Amount (AMI, HF, Pneumonia) $0 $0
Readmissions Reduction Amount (COPD, CABG, PTCA, OVC) #N/A #N/A
Reduction for High Rate of Hospital Acquired Conditions $0 $0
Value Based Purchasing Net Impact ($987,605) ($5,608,207)
ESTIMATED TOTAL IPPS IMPACT ($245,428) ($601,128) ($24,147,714) ($104,676,749)
Percent Change from Prior Law -0.17% -0.42% -13.99% -6.72%
ESTIMATED IPPS PAYMENTS UNDER PPACA $140,316,643 $142,772,184 $148,503,750 $1,453,358,563
2010 2011 2019 2010-2019
Expansion of Insurance Coverage (Optional Provider Estimate) $313,000 $9,880,300 $45,492,000
Percent Change from Prior Law 2.92%
COMBINED IMPACT OF IPPS CHANGES AND EXPANSION ($245,428) ($601,128) ($14,267,414) ($59,184,749)
Percent Change from Prior Law -0.17% -0.42% -8.26% -3.80%
ESTIMATED TOTAL IPPS AND EXPANSION PAYMENTS $140,316,643 $142,772,184 $158,384,050 $1,498,850,563
Example Data
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Optimize Current Processes: Keys to Success
Discipline
Accountability Measurement
Patient Access
Scheduling/ Pre-registration
Ins. Verification/ Authorization
POS Collections
Financial Counseling
Registration
Revenue Integrity
Charge Capture
Clinical Documentation
Chargemaster Management
Coding
HIM Throughput
Business Office
Billing
AR Follow-up & Management
Payment Posting
Customer Service
Collections/ Agency Management
Reimbursement
3rd Party Contracting
Denials Management
Contract Management
Pricing Strategy/ Fee Schedules
Revenue Recognition
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Gap Analysis
Current Performance
Good Performance
Better Performance
BEST PERFORMANCE
Good, Better, BEST!
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Example-Point of Service Collections
35
Example-Cost to Collect
36
Example-Bad Debt
37
• Pre-Service Model and Financial Clearance
• Pre-Registration, Eligibility/Insurance Verification,
Patient Payment Estimation
37
Patient Access
Patient Care
Patient Accounts
Revenue Cycle Optimization Pre-Service Model
38
Revenue Cycle Optimization Technology Integration: Bending the Cost Curve
Easiest Hardest Cash Collections
Co
st
of
Co
lle
cti
on
s
High
Low Increased Collections Collected
Current Future
40% Reduction
50% Improvement
• Use technology to improve performance and efficiency
• Reduce Cost-to-Collect (to < 2%)
• Use technology for repetitive, high volume transactions
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Our Message: Don’t Keep Doing The Same Old Thing!
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WHAT CAN YOU DO NOW?
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Sample Revenue Cycle Assessment
Low Mid High People Process Tech
Managed Care Contracting 2,300$ 4,100$ 4,700$ 6 9
Pricing Strategy 1,300$ 2,300$ 2,900$ 3 6
Centralized Scheduling 400$ 900$ 1,100$ 4 8
Verification/Eligibility 1,400$ 2,900$ 3,600$ 2 5
Point of Service Collections 800$ 2,100$ 2,800$ 2 6
Uncompensated Care 500$ 1,200$ 1,600$ 5 8
Charge Capture 700$ 1,300$ 1,800$ 6 9
Coding/Documentation 200$ 700$ 1,100$ 2 3
Chargemaster 500$ 1,400$ 2,000$ 4 5
Cost to Collect/Overhead Reduction 350$ 625$ 900$
AR Follow up workflow 900$ 200$ 2,500$ 4 6
Outsourcing Strategy 300$ 700$ 1,000$ 3 6
First Year Net P&L Impact: 9,650$ 18,425$ 26,000$ 8 10
Summary of Balance Sheet Opportunities Low Mid High People Process Tech
Discharge Not Final Billed (DNFB) 3,250$ 4,500$ 5,600$ 2 5
Unbilled Backlog 850$ 1,100$ 1,200$ 1 3
AR > 90-days 800$ 1,250$ 1,500$ 2 6
AR Reduction/Cash Acceleration 3,000$ 4,500$ 6,000$ 2 8
One-time Balance Sheet Impact: 7,900$ 11,350$ 14,300$ 2 8
Financial Impact Range
($000's) Improvement Opportunity
Estimated
Implementation (Time)
Range (months)
Range (months)
Summary of Income Statement Opportunities
Reimbursement
Pre-Service/
Time of Service
Revenue Integrity
Business Office
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Continuous Improvement: Where Do We Typically Find Opportunity?
Typical 300 Bed Hospital with $250 Million in Net Revenue…
• Income Statement Impact (Yearly Recurring Impact):
– Strategic Pricing $ 2,000,000
– Charge Capture Review 500,000
– Denials Management 1,000,000
– Point-of-Service Collections 2,500,000
– Agency Outsourcing Strategy
• Early Out 250,000
• Bad Debt 125,000
– FTE/Automation Productivity 1,250,000
TOTAL FINANCIAL IMPACT $ 7,625,000
• Balance Sheet Impact (One-Time Cash Flow Impact):
– Accounts Receivable (3-Day Improvement) $ 2,100,000
– DNFB (2-Day Improvement) 1,400,000
TOTAL FINANCIAL IMPACT $ 3,500,000
3% of
Net Revenue
Improvement
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Other Opportunities?
Speed revenue, achieve operational efficiencies, enhance compliance and reduce costs:
Implement Patient lockbox
Increased patient responsibility = $$$ in patient receivables
Postal Service budget cuts will increase mail times to hospital mail rooms, and may eliminate weekend mail delivery
Increased $$$ will increase audit concerns
HITECH raises standards for privacy/security, particularly for subcontractors such as outsourced mail operations
ROI is clear, and hospitals that have not implemented patient lockbox are behind the industry
Low-risk, high value way to begin a collections automation project
• Employees see immediate value
• Low requirement for hospital MIS involvement
Improve operational efficiency and cash optimization
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Other Opportunities?
Commercial lockbox
Same reasons as patient lockbox, but also sets the stage for process improvement, transition to IOCR
Look for national lockbox with corporate availability, virtual sorting, ability to sort by payer (MICR line), on-line images of lockbox checks/remits AND returned checks, ability to move to second generation IOCR
HITECH compliance
Direct 835/Re-Association
Electronic conversion of payments with direct 835…direct 835/EFT combinations maximimizes cash availability
Automatic re-association of data and dollars accelerates cash, ensures accuracy, enables staff to focus on exceptions
Ensure partner has good RIO for connections with lower volume payers not feasible for direct connections with provider (non-contract payers, payers secondary to Medicare, Workers Comp, auto)
Partner readiness will assist clients in converting from 4010 to 5010
Skilled on boarding and implementation consulting teams is important
45
Revenue Cycle Index Questionnaire
Required Statistic
1. Average Daily Net Patient Service Revenue (3-month DAILY Average)
2. NET Accounts Receivable Balance
3. Total Billed Accounts Receivable Balance
4. Billed Accounts Receivable Balance over 90-days old
5. Point of Service Patient Payments (Current Month Only)
6. Total Cash Collected (Current Month Only)
7. Total Revenue Cycle Cost (Current Month Only)
8. Net Revenue less Bad Debt Expense (3-month average)
9. Avg Daily Gross Patient Service Revenue (3-month DAILY average)
10. Gross Patient Service Revenue (Current Month Only)
Required Statistic
11. Average Monthly Bad Debt Expense (3-month average)
12. Average Monthly Charity Care Expense (3-month average)
13. Discharge Not Final Billed (DNFB) Accounts Receivable Balance
14. Claims Submitted to 3rd Party Payers without error
15. Total Claims Submitted
16. Total Liquid Cash
17. Average Daily Operating Expense
18. Percent of 3rd Party Payers submitting electronic remittances
19.Do you match (reassociate) electronic or paper remittances with
electronic payments? (1=No, 2=Yes)
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Revenue Cycle Index Questionnaire Required Statistic
20.ICD-10 training programs have been developed for your organization?
(1=No, 2=Partial, 3=Yes)
21.Internal development and testing of HIPPA Version 5010 standards
will be completed by 12/31/2010? (1=No, 2=Partial, 3=Yes)
22.
Workplans and timelines have been developed to complete external
testing of HIPPA version 5010 by 12/31/2011 with payers, partners and
providers? (1=No, 2=Partially developed, 3=Yes)
23.The organization will begin submitting HIPPA version 5010 claims
sometime in CY 2011? (1=No, 2=Yes)
24. Number of zero paid claims denied
25. Number of patient encounters pre-registered
26. Number of scheduled patient encounters
27. Total number of registered inpatient and outpatient encounters
28. Total number of verified inpatient and outpatient encounters
29. Total number of uninsured discharges
30. Total number of uninsured discharges approved for payer source
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Continuous Assessment of Clinical Payment Reform Benchmarks
• 1-day Length of Stay Admissions
• 3-day Length of Stay Admissions
• Hospital-Acquired Conditions (CMS hospital acquired conditions/HAC defined)/Payment Quality Indicators (PQI)
– Defined by specific CC/MCC ICD codes including; foreign object retained after surgery, air embolism, blood incompatibility, pressure ulcers, falls & trauma, catheter-associated urinary tract infection, perforated appendix, diabetes, dehydration, hypertension, COPD, congestive heart failure, angina, bacterial pneumonia, etc.
• 30-day Readmission Rate
– heart attack
– heart failure
– pneumonia
• Avoidable Admissions
– Patients admitted but due to their diagnosis, may be more effectively managed outside the acute care environment
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PNC Benchmarking Collaborative
• Measure the performance of the revenue cycle among acute care hospitals.
• Development of a PNC customer-based index that will allow us to measure the strength of an organization’s revenue cycle performance.
– This “PNC Index” will illustrate how well PNC customers are performing within the revenue cycle by comparing them to industry best practice benchmarks as well as comparing their respective performance to other PNC hospital peers.
• Approximately 30 non-PHI data points will be requested using financial data that is typically found on a monthly operating statement of an organization.
• There is no fee to participate in this survey, and results will be shared with the customer upon completion of this initiative.
• Provide an easy visual display of the organization’s revenue cycle performance against industry best practice and their peers.
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Benchmarking Collaborative Revenue Cycle Index – Sample
(1.00) (0.80) (0.60) (0.40) (0.20) - 0.20 0.40 0.60 0.80 1.00
Days Cash on Hand
DNFB
Net Days in AR
AR > 90-days
POS Collections
Cost to Collect
Cash to Net Revenue
Bad Debt Write-offs
Charity Care Write-offs
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Finally…a Demotivational Thought
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Contact Info
Marlowe Dazley – Senior Vice President
801-243-3202
Todd Halpin – Managing Director
801-243-9387
Dan Bergantz - Director
801-755-4628
