client case studies

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?


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.”


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.


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



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



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.


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


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.

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