Client Case Studies

1. Client Case Studies Presented by Andrew M. Allemao

2. Case Study One: Forms Using scanned images as the basis for auto generation of forms

3. 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

4. Business Requirement Filling 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.

5. Business Solution Partner with HLS to make the MSLW system produce the forms

6. 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

7. Why Scanned Forms? • Many forms are impossible to replicate in Word • Most payers will NOT accept forms other than their own

8. 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

9. HLS Scanned the Forms

10. HLS Added Variables

11. HLS Printed and Reviewed Sample

12. 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

13. Did We Meet our Goals? Goal 1: Reduce the amount of time to complete a payer credentialing application by 50%.

14. Breakout of Estimated Time Savings

15. Did we meet our goals? Goal 2: Increase the accuracy and consistency of the information being disseminated.

16. 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)

17. 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.

18. Case 2: Custom Survey Reports Genera Managed Care Site Visit And Medical Record Audit

19. 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.

20. The Solution The solution was to: • Use the Survey Module within MSLW to build and complete the surveys • Work with HLS to design an intranetbased reporting mechanism to allow the two offices involved to “self-serve” the reporting that is meaningful to them

21. 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

22. 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 Two Offices - Different Needs

23. 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”

24. Start Survey Visit Medical Record Review Site Survey Critical Met? Corrective Action Review Corrections No Yes Pass? Corrective Action Review Corrections No Yes Print Reports MR Review Site Survey Scorecards End Survey Process

25. The Selection Screen

26. Results Screen • From this screen client can either: • Print Surveys and Scorecards, or • Print Action Plans

27. Medical Record Audit Medical Record Audit has 23 questions 5 charts are reviewed per provider Thescore is calculated automatically

28. Site Visit Survey • Site Visit Survey has 164 questions • Designed to meet several different regulatory requirements • Automatically calculates a “Score”

29. Site Visit Survey Areas The information on the Site Visit Survey covers all of the standards required by NCQA.

30. Scorecard Summary page from the reviews

31. 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?

32. 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.”

33. 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.

34. 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.

35. 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. HLS GHS

36. Case Study Three: Reappointment Process General Observations from Usage Assessment Visits

37. 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.

38. 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)

39. Common Goal • Reduce the number of resources necessary to complete the credentialing process • Number of person hours • Office equipment

40. Common Process Most of the hospital clients we work with have a similar Reappointment Process.

41. Common Areas for Improvement • Creation and sending of the reappointment packet

42. 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

43. Send Reappointment Packets The Quick Report

44. Common Areas for Improvement • Creation and sending of the reappointment packet • Verification letter sending & tracking

45. 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

46. Setting up the Letter to Record The first step in the tracking process is to record the sending of the letter

47. Recording the Letter Once set up to record, a verification letter record will be created each time you send a verification letter.

48. 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

49. Use Sent/Rec’d dates for Follow-up Recorded in the Doctor’s Record Filtered for Using the Reporter

50. Common Areas for Improvement • Creation and sending of the reappointment packet • Verification letter sending & tracking • Use of checklists to track the process