Client Case Studies Presented by Andrew M. Allemao
Mar 18, 2016
Client Case Studies
Presented byAndrew M. Allemao
Case Study One: Forms
Using scanned images as the basis for auto generation of forms
Client Profile
Contract management company Affiliated with a large healthcare
system in New York Responsible for payer credentialing
of over 6,000 providers with an average of 10 associated payers each
Business RequirementFilling out insurance plan applications is a service that this client believed was a requirement of competing in their industry. Therefore, the client needed to find a cost effective way to accomplish this using the tools already in place.
Business Solution
Partner with HLS to make the MSLW system produce the forms
Two “Simple” Goals
Reduce the amount of time required to complete a payer credentialing application by 50%
Increase the accuracy and consistency of the information being disseminated
Why Scanned Forms?
Many forms are impossible to replicate in Word
Most payers will NOT accept forms other than their own
Why Outsource?
Resource constraint Skill set:
Skill level with Word did not include image attachment and complex formatting (tabs, line spacing, fonts, margins, page settings)
Limited experience with image manipulation
HLS Scanned the Forms
HLS Added Variables
HLS Printed and Reviewed Sample
Lessons Learned Images can be large, so the
template documents for 20 page forms can exceed 2 MB
Need a powerful PC for large forms runs
Need either a print server with a lot of space allocated or a printer with a lot of memory
Did We Meet our Goals?
Goal 1: Reduce the amount of time to complete a payer credentialing application by 50%.
Breakout of Estimated Time Savings
FormNumber of Pages
Hours/form Manual
Hours/form Automatic
Time Savings
Cigna 7 1.00 0.33 67%UHP 7 1.00 0.33 67%Galaxy 5 0.75 0.17 78%GHI 8 1.25 0.33 73%Medicare 2 0.25 0.08 67%Aetna 12 2.25 0.33 85%Americaid 4 0.50 0.17 67%Anthem 4 0.50 0.17 67%Consumer Health Network 7 1.00 0.33 67%Empire Health 7 1.00 0.25 75%First Health 6 0.75 0.17 78%American Assn of Health Plans 11 2.00 0.25 88%MagnaCare 8 1.00 0.25 75%MasterCare 3 0.50 0.08 83%MultiPlan 7 1.00 0.17 83%One Health Plan 9 1.25 0.33 73%Oxford Health Plans 15 2.00 0.33 83%QualCare 6 0.75 0.17 78%United Healthcare 8 1.00 0.25 75%
Did we meet our goals?
Goal 2: Increase the accuracy and consistency of the information being disseminated.
Increase in Accuracy/Consistency
Single data source (MSLW) for all forms ensures consistency between forms
MSLW’s relational data structure aids data integrity
Accuracy is client dependent (GIGO)
Summary
The key to success in a low-margin, manually intensive industry is to find ways to save labor. We were able to save this client an average of 75% per form in labor.
Case 2: Custom Survey Reports
Genera Managed Care Site Visit
And Medical Record Audit
Business Requirement Ensuring that the provider practice
locations meet standards outlined by NCQA guidelines and that the documentation is also appropriate, is a big job. GHS needed a way to collect and disseminate this information in the most efficient method possible.
The SolutionThe solution was to: Use the Survey Module within MSLW
to build and complete the surveys Work with HLS to design an intranet
based reporting mechanism to allow the two offices involved to “self-serve” the reporting that is meaningful to them
Goals of the Project Reduce the cost of tracking Site
Review and Medical Record Audit results
Facilitate compliance with NCQA accreditation standards
Enhance work flow between the verification office and site reviewers
Two Offices - Different Needs
Reviewers
Need to be able to quickly tell what follow up needs to be done
Produce a plan of action for correction of “critical elements”
Verification Office
After all of the review/correction is done, must print final copies of the surveys for inclusion in the file
Key Terms Critical Elements – Items that MUST
be met in order for the provider to be contracted for that location
Scorecard Each criteria is assigned a weighted value The weighted total percentage is
compared to a benchmark passing score to determine “Pass” or “Fail”
Survey ProcessStart
Survey Visit
CriticalMet?
End
Pass?
Print Reports
Review Corrections
Corrective Action
Review Corrections
Corrective Action
Yes
Yes
No
No
Medical Record Review Site Survey
MR Review Site SurveyScorecards
The Selection Screen
Results Screen
From this screen client can either:• Print Surveys and Scorecards, or• Print Action Plans
Medical Record Audit
Medical Record Audit has 23 questions5 charts are reviewed per provider
The score is calculated automatically
Site Visit Survey
• Site Visit Survey has 164 questions• Designed to meet several different regulatory requirements• Automatically calculates a “Score”
Site Visit Survey Areas
Accessibility
Appearance
Policy & Procedure
Safety Infection Control
Pharmacy
Emergency Care
Exam Rooms
Lab
Radiology
The information on the Site Visit Survey covers all of the standards required by NCQA.
Scorecard
Summary page from the reviews
Action Plans
All Critical Elements Not Met require action. Tracking includes:• When was the problem identified?• What process needs improvement?• What is going to be or has been done to correct the issue?• When? • By Whom?
Did we meet our goals?
Goal 1: Reduce the cost of tracking Site Review and Medical Record Audit results.
We will see… Client is quoted as saying this process improvement will save them “lots of hours.”
Did we meet our goals?
Goal 2: Facilitate compliance with NCQA accreditation standards.
The surveys themselves are the clients key to compliance. The ability to automate follow-up clearly helps ensure that the standards for accreditation are met.
Did we meet our goals?
Goal 3: Enhance work flow between the verification office and site reviewers.
Prior to having this system in place, the reviewers needed to explicitly forward the information to the Verification Office. Now the CVO can print these reports for themselves.
Summary
This is an excellent example of a client thinking in terms of continuous process and quality improvement, and working with us to make it happen.
Case Study Three: Reappointment Process
General Observations from Usage Assessment Visits
Business Requirement
For most of the clients with whom we consult, the most time consuming part of their operation is the 2-year reappointment process. Many of them are constrained by bylaws and it is difficult to change policies and procedures.
Business Solution Find a better, more efficient way to
perform the process outlined in the bylaws or defined in the Credentialing Policies and Procedures.(Note: Where it makes sense, we look for process improvement. However, many organizations are understandably resistant to change a major process that impacts their JCAHO review)
Common Goal Reduce the number of resources
necessary to complete the credentialing process Number of person hours Office equipment
Common Process
Most of the hospital clients we work with have a similar Reappointment Process.
Common Areas for Improvement
Creation and sending of the reappointment packet
Send Reappointment Packets
• Create filter to pull physicians scheduled for reappointment• Build a listing report to view who is up for reappointment• Build the physician reappointment profile• Build reappointment packet cover letter• Build verification letter set• Run this all at once using Quick Reporter
Send Reappointment Packets
The Quick Report
Common Areas for Improvement
Creation and sending of the reappointment packet
Verification letter sending & tracking
Verification Letters Tracking Record every external verification in
the verification letters area of the software
Use the sent date and received date fields as the basis for the verification follow-up
Use electronic verification where possible
Setting up the Letter to Record
The first step in the tracking process is to record the sending of the letter
Recording the Letter
Once set up to record, a verification letter record will be created each time you send a verification letter.
Recording the Letter Receipt
If you have used the #PostMaster# variable in MSLW/ECHO, you can quickly record receipt of the letter using the verification letters received screen
Use Sent/Rec’d dates for Follow-upRecorded in the Doctor’s Record
Filtered for Using the Reporter
Common Areas for Improvement
Creation and sending of the reappointment packet
Verification letter sending & tracking Use of checklists to track the process
Use a Checklist to Track StatusEach milestone is a checklist item
Use a checklist to track status Allows for turn-around time reporting Allows for easy identification of
records that need special attention Assists in sticking to policies such as
the dreaded... “This reappointment packet must be completed and returned no later than XX days”
Did we meet our goal?
There is a marginal savings in office equipment due to the potential scanning of key documents for on-line review. However, the BIG savings in the reappointment process described here are labor related.
Did we meet our goal?
Task Old Method New Method $ Savings% SavingsHours/File Cost(1) Hours/File Cost(1)
Create and Send Letters 3 75 0.75 18.75 56.25 75%Tracking 2 50 1.00 25.00 25.00 50%Review Prep 2 50 0.50 12.50 37.50 75%End Process 2 50 0.50 12.50 37.50 75%Total 9 225 2.75 68.75 156.25 69%
(1) Cost assumes a fully burdened rate of $25/hour labor cost
Did we meet our goal?
02468
10
Hour
s
Prior NewPrior 9 Hours /
New 2.75
Hours/ File - Reappointment
CloseOut
File Prep
Tracking
Create &SendLetters
SummaryOur consulting clients all have a solid grasp of their requirements, both internal and external. They also know their “approved” policies and procedures. A few client specific hints and tips help put the pieces together.