A Guide to Implementing an Effective Healthcare Solution

Matt Gretczko — Fri, 22 Nov 2013 14:21:00 GMT

The term solution is not overused. It is misused.

Many times it is utilized by organizations to describe offerings that do not meet the full intent of the terminology. To me, a solution is not just a fix. It is not just one piece of technology. It incorporates a number of activities, working in harmony, to ensure that an organization meets its intended strategic goals after completing a project.

Solutions Are Not Easy to Implement

Too often in healthcare, organizations focus on fixes as opposed to solutions. This results in short-term benefits leading to either a reemergence of the same issues, or the creation of new ones. Organizations must first identify tangible strategic goals and the associated outcomes they desire, and then they can seek out comprehensive solutions. Several potential objectives that come to mind include the following:

Moving from a two-year credentialing cycle to a continuous credentialing state, ensuring providers are perpetually “privilegeable”
Automating FPPE/OPPE processes so that they can be objective, standardized, and transparent resulting in mutual benefits to both the organization and provider, as opposed to being an administrative hindrance
Development of shared service centers capable of performing onboarding activities (recruiting, credentialing, privileging, enrollment, etc.) with much more efficiency. This not only eliminates risk and duplication, but also ensures adaptability to an ACO model where providers work in multiple locations and more patients have coverage
Proactive compliance reporting and risk management through an end-to-end platform that consolidates data across business units
Improved satisfaction for both patients and providers through effective engagement and communication tools
Detailed, and accurate, quality metrics for providers that help ensure coordination between clinical outcomes, billing activities, and hiring processes

The key is getting your organization to make goals like these.

Once your organization determines its strategic objectives, then it must actively scour the healthcare market to find vendors that actually understand these goals and provide solutions to deliver on the intended outcomes. Vendors that successfully deliver solutions, as opposed to fixes, generally include the following activities in the offering:

Project Management – Pretty straightforward, yet critical and often complex. This requires a focused discipline that effectively communicates, manages risks, meets milestones, holds resources accountable, and constantly aligns effort with the intended outcomes. Project management also ensures the appropriate deliverables (management and staffing plans, operational plan, etc.) are effectively developed. The appointment of an executive steering committee to demonstrate leadership and guidance towards the end game is also highly encouraged.

Change Management – If you are investing money on a solution, it is safe to assume that something will change. Change management ensures buy-in. All stakeholders are effectively communicated to, trained, and involved to ensure a seamless transition.

Process Alignment/Redesign – The old adage of people, process, and technology holds true. Most solutions require implementing or optimizing technology. However, technology is only as good as the people who use it, and the processes that align to it. A true solution always ensures that the processes align to the technology, which may require redesign as some become automated and others evolve.

Scaled Rollout/Transition – It is never a good idea to roll-out a solution without testing it first. Leveraging a beta/pilot program ensures a reasonable plan that validates and “operationalizes” the solution in a controlled environment. This allows the opportunity to make the necessary tweaks to skills, processes, and technology to ensure an effective roll-out to the entire user population.

Adoption – Go live is not the end goal. Adoption is. Following a successful implementation, it is critical that your organization constantly communicates to its employees and stakeholders to ensure that they are optimizing the implemented solution.

So What’s the X Factor? In Many Cases, Technology

Most solutions, at least in the current environment, incorporate some form of technology. This may be new technology, or optimization of technology currently in place. However, often organizations select a “technology” while disregarding the above activities and thus are dissatisfied with the inability to achieve their strategic goals. Therefore, organizations must incorporate the aforementioned activities in combination with technology, which may, or may not, require external assistance to deliver.

What’s the lesson?

Don’t just implement a fix. Understand the complexity, scale, and scope of the strategic imperatives for your organization and enlist the support needed to implement a successful solution – one that is comprehensive. Going for the cheapest, or easiest approach may seem like a great short-term decision, but in the long-run, it may pose significant risks to your organization.

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About the Author

Matt Gretczko is a Founding Partner of SEERhealth primarily responsible for leading the development of the SEERhealth platform, initial client roll-out strategy, and ongoing implementation methodology. Matt has nine years of consulting experience, previously working at Deloitte where he provided global process redesign, technology implementation, workforce analytics, and change management services. VIEW FULL PROFILE

The Importance of Collaboration in Your Hospital

Matt Gretczko — Tue, 19 Nov 2013 19:41:00 GMT

I attend a number of conferences throughout the year. The most obvious intents of attending such events for many organizations are sales, marketing, and brand eminence. However, what is often overlooked is the unique opportunity these events present to educate the market on the most cutting-edge solutions and trends within the healthcare industry.

Education is a great promoter of forward progress. Healthcare professionals, regardless of their role, need to be well informed of all of the relevant solutions and technology that can help drive efficiency, improvement, and coordination to reach the strategic goals of their organization.

What is most surprising is that the structure of conferences validates one of the greatest impedances to making some of these goals a reality – they are segregated by business functions. Risk professionals go to ASRHM. Credentialing professionals go to NAMSS. And so forth. I am not suggesting we change the conferences; I am suggesting we change the mindset that a siloed approach to business unit operation is effective.

Let’s eliminate these misnomers.

“I didn’t know we could do that.”

“I have no idea what system they use.”

“Regulation does not allow me to share with them.”

Professionals who perform different activities within their business, but leverage the same information to drive complementary outcomes, need to coordinate and collaborate. All of the following activities - recruiting, credentialing, privileging, quality, peer review, and enrollment – can be managed on the same platform to eliminate duplication.

There is no reason why Risk Management, Quality, Legal, and Medical Staff Offices are not sharing information about providers to create a more streamlined and efficient process. This is one small, yet critical, niche of activities within a healthcare organization.

So why does this problem continually exist? Here are a few reasons why:

“Point Solutions” are rampant – Organizations often struggle with the ability to balance multiple efforts due to human capital constraints, competing priorities (ACO, EMR, etc.), or financial restrictions. In turn, organizations select a solution for one small issue without recognizing the impact or effect it may have on other activities. Therefore, this leads to disparate systems, multiple users groups, complex integration, and lack of data visibility
First come, first serve – This works great in the restaurant industry. However, it is not as effective in other industries. One of the greatest errors that organizations make is that they pick the first solution that is pitched to them. This is a major risk. It does not allow the appropriate time to vet options or ensure alignment to organizational goals, and often leads to lengthy contracts that produce little results. Instead, organizations must perform detailed assessments both of their organization, and potential solutions, before making a decision
Constant Reprioritization – Change is inevitable and will be even more prevalent in the healthcare industry in the coming years. Although reprioritization is critical to effectively run a business, this prioritization must be done in coordination with capital investments. Often, organizations invest in the next “big thing”, without looking strategically at how an investment in one area may need to coordinate with investments in other areas. For example, organizations are investing tens of millions of dollars implementing EMR solutions without confirming if they can integrate with their technology that currently drives credentialing, privileging, and quality activities
Lack of “good” knowledge – There is so much information available to people in their personal and professional lives that it is often hard to decipher the information to drive the appropriate decision making opportunities

The most cutting edge organizations recognize that the ongoing changes within the healthcare industry continue to add complexity and burden onto everyday activities for professionals throughout their organization. However, in order to truly focus on the areas that are most critical – delivering high quality patient care and staying in business (the financials) - they must have an infrastructure that can adapt and evolve on an ongoing basis. An infrastructure that provides these results is one that optimizes the organizations ability to coordinate and collaborate across business units, which leads to less duplication, greater transparency and visibility of data, and tangible outcomes.

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Risk Management: It's Everyone's Responsibility

Matt Gretczko — Tue, 12 Nov 2013 15:13:00 GMT

Risk management is a rather colloquial term. It is tough for anyone to determine exactly what it entails in any and all business environments.

But I can tell you one thing – everyone must manage risk, even if it’s not in your job title. This is especially true within healthcare. Just because you do not work in the “risk management” department, this should not be seen as a missing part of your job responsibilities; it just comes in a variety of forms.

Across healthcare organizations, there are a number of activities that occur to ensure that risk is minimized:

Credentialing - Defines who a provider is. Credentialing includes a provider’s initial vetting, and ongoing verification of their competencies and requirements to practice medicine.

Privileging - Specifies what a provider can do in a clinical setting. Privileges are continuously updated based upon ongoing training, patient care delivery, and facility-specific capabilities.

Payer Enrollment - Initiates and sustains provider reimbursement eligibility.

Performance Monitoring - Performance monitoring measures how a provider has performed.

Peer Review and Evaluation - Focuses on improving quality, outcomes, patient satisfaction, and lowering costs.

Sanctions Monitoring - Ensures that providers are in good-standing with insurers and other institutions.

The aforementioned are ambivalent of a specific department within an organization. The “Risk Management” department does not own all of these tasks, nor are all forms of risk being addressed in the short list above. Instead, these activities occur on a continual basis to minimize risk. In addition, the most cutting-edge healthcare organizations have systems that store quality, billing, and performance data to drive these activities.

Why is this important?

One of the many specialized capabilities of risk managers is addressing specific instances where a risk case arises and determining cause, potential fault, and successful remediation. However, the Medical Staff Office, Legal, Quality, Patient Safety, HR, and a mixture of other departments may be involved in completing the other activities that try to minimize these instances. It is important for risk management to be a tenet of every department and employee at an organization.

It is less important to outline every possible instance of risk, than it is to recognize that risk management must be top of mind for all professionals within a healthcare organization. This will ensure that the processes and technology that drive the organization forward are appropriately aligned to proactively address potential issues in the future.

Therefore, risk management can be a case study for the variety of business functions within a healthcare organization where coordination and collaboration is critical.

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The 5 Standards of Provider Engagement

John Damouni — Mon, 04 Nov 2013 14:42:00 GMT

The Importance of Provider Engagement

Provider engagement is one of the strongest factors driving healthcare organizations’ long term financial success. Abundant research proves that a disengaged workforce negatively impacts organizations in all industries. An alarming healthcare-specific example showcased by a Gallup organization study claims that low provider engagement contributes to a 41% increase in patient safety incidents. While the aforementioned statistic calls for immediate action, leaders often struggle with effectively engaging their workforce. This should no longer be the case. Leaders in pursuit of boosting engagement must adapt and personalize their approach depending on environmental, personal, and generational factors. While circumstances differ across industries, the following five standards serve as a compass for leaders wishing to boost provider engagement in the healthcare industry:

Create a Strong First Impression: Engagement begins prior to a provider’s first day at work. Every interaction during the interview, hire, and onboarding stages is an opportunity to establish an emotional connection between the employee and the organization. It is also a vetting process for the organization to determine if the provider will ultimately be a “good fit.” Positive indicators, in both directions during these activities, ensure that the provider will remain engaged throughout their career with the organization

Connect the Dots: Providers and healthcare professionals must understand how their individual roles contribute to the organization’s strategic direction, including the financial components and goals of the organization. The clinical workforce must be able to recognize the firm’s overarching mission and vision, and then tie it back to their individual roles and responsibilities. Success in this effort requires healthcare leaders to consistently communicate with their teams in a clear, honest, and straightforward fashion

Sense of Ownership: Perhaps the most meaningful step in engaging providers is instilling a sense of ownership. Promoting ownership begins with empowering the workforce to influence the work that affects them, and be held responsible for their contributions. Timely communication and thorough feedback is paramount in this step. A sense of ownership drives loyalty and commitment as healthcare leaders develop others professionally, build trust, and strengthen engagement

Success Path: A common trait of successful leaders is their ability to set others up for success. Often, an organization’s own rules, processes, and practices become roadblocks to their own long-term success, impeding productivity and reducing engagement. Organizations must invest in continuously reviewing their internal operation to remove unnecessary practices that impact fostering a positive and productive work environment. Furthermore, successful providers thrive on working with other successful providers. An organization bears responsibility for building a team with shared values and principles so members can collaborate, hold each other accountable, and own their path to success

Recognition: Talented providers and healthcare professionals seek to continually progress in their career, utilize their skills and knowledge on a daily basis, and contribute to the underlying goals of the organization. In addition, being recognized for their dedication and achievements is also critically important. Leaders, who are successful in driving engagement, understand that employees are the organization’s most valuable asset, and often go to great lengths to ensure that they achieve those goals while feeling appreciated and valued. More importantly, the most effective organizations personalize their form of recognition accordingly. For example, one provider may thrive on public recognition, while another may benefit from improved work/life balance, or increased opportunities for growth

Engagement, particularly in healthcare, is driven by a genuine desire to help others, improve the patient experience, and enhance quality. Each of the standards above is dependent on a leader’s desire and ability to listen and communicate with their clinical workforce in an effective manner. Healthcare leaders must drive a sense of mission that inspires employees on a daily basis to achieving the organization’s goals, which can only be achieved through an engaged workforce.

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John Damouni is a Client Partner at SEERhealth with responsibility for supporting the client relationship management implementation and marketing initiatives. Prior to joining the SEERhealth team, John held leadership positions at world-class service organizations including the Ritz-Carlton Hotel Company.

John is noted for his expertise in implementing successful customer relationship management processes, as well as developing and sustaining strong client relations teams. VIEW FULL PROFILE

Provider Management Solutions: Merging Important and Difficult Issues

Matt Gretczko — Tue, 17 Sep 2013 13:45:00 GMT

In a study by The Estes Park Institute entitled, “Top Issues in Healthcare 2013,” exit surveys of 450 attendees at five different healthcare conferences were conducted to assess fourteen healthcare issues. Outside of the obvious value of the base statistics presented, this was an incredibly intriguing piece of research for me because I believe it succinctly illuminated one of the largest impediments to modernization and improvement in the healthcare industry – a lack of emphasis on the relationship between the importance of an issue and the difficulty to implement a solution for its remediation. In addition, the data also provides clarity on what truly are the “issues” (at least from a subset of the industry), as opposed to focusing on topics that gleam the media spotlight.

The following results were summarized in the study:

Top Five Most important Issues:

Getting adequate reimbursement from Medicare
Changing the healthcare delivery system to be more effective and less costly
Getting adequate reimbursement from Medicaid
Improving patient safety
Cutting costs while delivering better care

Top Five Most Difficult Issues:

Getting adequate reimbursement from Medicaid
Changing the healthcare delivery system to be more effective and less costly
Getting adequate reimbursement from Medicare
Cutting costs while delivering better care
Getting adequate reimbursement from commercial insurance carriers

Is this list surprising? No. It is also worth noting that not all healthcare issues were included in this study. However, it is significant that many of the issues outlined do not necessarily align to the most burdensome efforts and projects that leading healthcare organizations dedicate resources to. The main reason for this is that many organizations are not aware of comprehensive and large scale solutions that exist in the marketplace today – solutions, might I add, that can resolve many of the issues that are both important and difficult.

Let’s look at the themes.

Cost. Value. Quality. Reimbursement. A survey of this type not only helps organizations understand what is top of mind, but it also ensures that the industry aligns solutions to these problems. No one can argue that cost, value, quality, and reimbursement are front and center issues for all healthcare executives. However, what is critically important is that these same executives find an integrated solution, a provider management solution, to address these concerns.

These types of “Provider Management Solutions” tend to have the following characteristics:

An integrated, SaaS-based platform to consolidate business activities amongst units and functions – recruiting, credentialing, privileging, enrollment, billing, and quality
Shared service centers that drive standard, efficient, and streamlined processes serving all customers – both internal and external
Dedicated resources focused on change management, communication, and adoption of the new strategies over time
An engaged, and informed, executive oversight committee to provide strategic direction and buy-in
A phase-based, and detailed, implementation plan that effectively assesses the organization, customizes the solution, and implements it in a manageable and scaled timeframe
Integration of best practices to not only meet all regulatory guidelines, but to provide agility for changes in the future

So what do we do with this information?

This is the key question. Four of the five most important issues are also perceived as the most difficult to implement. Furthermore, it is rather clear that board members, management, and physician leaders generally have the same perspective on what is important. In order to select the most meaningful project, organizations must enlist groups of business leaders, across all levels, to effectively assess and prioritize accordingly. This process will force the organization to look at the aggregate data, from all business units, to make the most informed business decisions on what global solution to implement, as opposed to looking at disparate data points for one-off solutions that do not drive the long-term results they are seeking.

If organizations follow the aforementioned approach, they will start to recognize the value of these broader provider management solutions. When implemented, solutions of this type will lead to reduced costs, faster reimbursements, and increased quality which will help meet the industry’s transition from a focus on quality as opposed to service.

These results are achieved through the following outcomes:

Optimized revenue management
Minimized bad debt from payer enrollment gaps
Reduced administrative redundancy
Improved provider engagement and retention
Simplified compliance reporting
Objective, transparent, and standardized performance evaluation and peer review processes
Proactive risk management

Given the current economic, regulatory, and technological changes, now is the time for your organization to assess its operations so it can capitalize on the markets’ ability to provide custom, cutting-edge solutions for the most important, and most difficult, issues. It is no longer sustainable to focus on addressing one issue at a time and hope to maintain a competitive edge within the healthcare industry.

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Direct Care: Press "0" To Improve THE Experience

Matt Gretczko — Fri, 23 Aug 2013 14:35:00 GMT

Whether you have stayed at a luxury hotel or not, it is rather common knowledge that while staying at these accommodations, guests have the opportunity to press “0” on their phone. Unlike in the customer service world for consumer products (where “0” may just forward you onto the next computer automated sequence), within the services industry, this selection often directs you to a concierge - a dedicated representative who is focused on answering any question you may have or fulfilling your every request. Concierge services provide the guest with direct access to a highly-trained individual, on their schedule, who can address their concerns. Seems similar to what we want from healthcare? You bet.

This is the concept of direct care and it has been around for a while. However, it is being rebranded and experiencing a significant increase in popularity given current healthcare regulations and changing patient statistics.

Concierge. Boutique. Direct care.

There are many different names. The growing need to provide patients with greater transparency and healthcare access, coupled with changing patient demographics and reimbursement policies, have led to a new population of providers focused on direct medicine. Charging a minimal fee (annual or monthly), paid by patients (regardless of their insurance), to guarantee some of the following services:

24/7 access to the doctor
Same day/last minute appointments
Decreased appointment wait times
Extended doctor visits
Alternative consultation methods (i.e. email)

As outlined in a Forbes article entitled, “Is concierge Medicine Right for You,” the author details that this approach can have a number of benefits, including:

Relative affordability of the service
Choice creates flexibility
Patient benefits – decreased costs due to less hospitalizations and readmissions
Physician benefits – greater job satisfaction

The goal of this transition to concierge health service is to develop a model where patients receive high-quality care at a fair price. In addition, it seeks to alleviate many of the frustrations of providers, and patients, within the rapidly changing healthcare landscape. Although this may not be a viable approach for the entire country, if a subset of patients and doctors are able to reach an amicable agreement, it may assist in lessening the burden and creating more efficiency for the broader population.

It’s not just for delivery of care

What’s even more intriguing about this trend is that concierge type service levels are not only being desired and implemented for the delivery of care to patients; many organizations, companies, and technologies are capitalizing on the global request by providers to have a more refined experience as well. Providers often seek out healthcare systems or companies that provide a concierge-like approach to onboarding and credentials management. This ensures that the bi-annual maintenance of credentials, as well as activities like privileging and enrollment that may potentially occur across multiple hospitals or practices, is less about documentation and more about information. Providers have direct contact with trained professionals who consistently and effectively notify them of upcoming document expirations and needed certifications or licenses, to ensure that they are not hassled consistently throughout the year. In addition, this information is maintained electronically to eliminate the complexity of paper.

Organizations have often found that by consolidating these activities into a shared service center whereby economies of scale can capitalize on technology and processes, the business case for such a switch is rather seamless.

With that said, this is not an article about the benefits of customer service. This is an article about ensuring the market finds the most effective way to deliver services to people – supply/demand economics applied to healthcare. Concierge or direct medicine may not solve all of the issues within the healthcare space; it may even cause additional ones. However, the industry must start recognizing the need to adopt creative and alternative solutions to delivering care, regardless of the healthcare policies that are instituted.

Healthcare is not alone in this endeavor. The hospitality industry has also made some tweaks. Recently, as outlined in an article by Yahoo! Finance, entitled “The End of Restaurant Tipping,” many high end restaurants have started to eliminate tipping and instead have imbedded the projected “cost” of tip into total meal price. The implication is not that higher costs equate to better service. Instead, the goal is to realign the nexus of cost to create more desirable results. In doing so, it helps ensure that the services provided equate to the price being charged. They believe this will inherently raise the level of service delivered to the customer, resulting in a better experience at the same total cost. Even further, a plethora of applications for smartphones have determined how to better deliver standard services (taxis, laundry, food) in a more effective manner (i.e. on demand).

This time around, healthcare needs to lead the charge as opposed to following behind. Healthcare can capitalize on the trend of delivering services in more creative and effective manners by instituting new models and processes, and also leveraging technological advancements that make information sharing and communication much easier across the enterprise.

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3 Trends that are Transforming the Patient Experience

John Damouni — Thu, 08 Aug 2013 16:05:00 GMT

The healthcare industry has historically been slow in adopting changes that have previously been implemented by other industries to enhance the processes, service levels, and efficiency of business operations. Intensified focus on research and development efforts during the “technology era,” specifically during the last several decades, has led to impressive medical advancements that have transformed the healthcare industry.

However, in order for patients to receive an improved medical experience at healthcare organizations, the focus on enhancing the patient experience must be top of mind, and not just a secondary organizational goal. In recent years, a combination of operational, regulatory, and technological changes specific to healthcare has made the patient experience front and center, compelling healthcare executives to focus on improving operational practices to enhance quality and promote patient experience.

The following trends are an output of the changes that have proven to be the key driving forces behind the recent undercurrent stirring change in healthcare:

Cross Industry Trends:

There is a discrepancy between service levels in healthcare and other industries, such as hospitality and aviation, which is prompting healthcare patients to desire and seek the same level of service that is offered to them as customers of businesses operating outside of healthcare. Needless to say, the nature of healthcare presents unique challenges, but the basic service values are often missing from healthcare organizations. According to recent national HCHAPS survey results, such service values include responsiveness of staff, cleanliness and quietness of hospital environment, and communication regarding course of treatment.

Technology:

Technological advances have changed patients’ interactions in two ways. Social networks provide patients with an effective medium to share their experiences and learn about other patients’ interactions with the organizations. In addition, patients now have access to a variety of online medical journals and resources that they can reference in order to become more knowledgeable and in-tuned with their medical well being and overall health. This knowledge propels patients to become more involved in health related decisions, previously made by providers without their influence or inquiry.

Regulatory Changes:

The Accountable Care Act and Medicare’s Value Based Purchasing Program are among the new regulatory developments that are dramatically changing the industry’s landscape. Accountable Care Organizations (ACOs) are now forming with the intent of caring for community members residing within a specified geographical area. ACOs now bear responsibility for collaborating with the patients that they serve to improve the overall health of the community in order to reduce their costs. Value Based Purchasing (VBP) ties a percentage of Medicare reimbursements with the organization’s quality and patient satisfaction scores. VBP encourages healthcare organizations to improve their service levels, and more importantly, their internal quality practices that inherently drive higher service levels.

Healthcare patients have evolved to become more savvy and in-tune with their health and well-being. While improving the patient experience has always been a goal, the aforementioned trends are empowering patients and healthcare leaders to work together and invest in drastically improving healthcare's quality and service practices.

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John is noted for his expertise in implementing successful customer relationship management processes, as well as developing and sustaining strong client relations teams. VIEW FULL PROFILE

The Future of Healthcare: Provider Management is Critical

Matt Gretczko — Thu, 20 Jun 2013 13:14:00 GMT

Provider Management. New term - maybe. New business - no.

Provider Management is a unique niche within healthcare that is only recently gaining steam as its impact on the broader healthcare landscape becomes apparent.

I began my professional career as a Human Capital Consultant – playing multiple roles on global projects focused on Human Resource process improvement, outsourcing, technology implementation, change management, and workforce planning. All of the projects I was involved in, inherently, tied to the notion of Human Capital Management; the strategic approach and processes associated with effectively managing your organization’s most important resource – people. Human Capital Management often includes, but is not limited to:

Recruitment
Talent Management (succession planning, performance management, etc.)
Human Resource Management (benefits, workforce planning, etc.)
Payroll Administration
Time Tracking

What’s intriguing is that the standard approach to this process works in most, but not all industries. One industry that introduces complexity is healthcare. Within healthcare, you have a defined set of resources – Providers – that have a truly unique set of requirements to effectively become members of the staff and help drive some of the long-term outcomes the organization desires – engagement, revenue, and successful patient outcomes through the delivery of high quality patient care.

This reality requires a unique solution to complement the standard Human Capital Management approach.

Enter Provider Management

Provider Management is when your organization leverages fully integrated technology-enabled services, coupled with modernized processes and consolidated business practices, to transform the way you manage providers. This allows organizations to more effectively unify and improve the continuum of activities that establish and maintain the working relationship between providers, health systems, and payers. This removes inefficiency, redundancy, and decentralization that often plagues health systems. Some of the specific components of Provider Management that differ from Human Capital management are the following:

Credentialing
Privileging
Appointment
Payer Enrollment
FPPE/OPPE
Quality Improvement
Risk Management

The unique components of Provider Management ultimately roll into the broader Human Capital Management at your organization. However, it is critical to have the correct processes and technology to ensure alignment to the appropriate regulations, bylaws, and desired organizational outcomes.

When Provider Management solutions are successfully incorporated into the strategy of healthcare organizations, the following outcomes can be achieved:

Streamlined Onboarding Process
Optimized Revenue Management
Minimized Bad Debt from Payer Enrollment Gaps
Reduced Administrative Redundancy
Improved Provider Engagement and Retention
Simplified Compliance Reporting
Objective, Transparent, and Standardized Performance Evaluation and Peer Review Processes
Proactive Risk Management

Organizations continue to address recent changes in the healthcare industry through dedicated projects such as facility consolidation, EMR Implementation, ICD-10 conversion, and patient safety and quality improvement. These are all significant and critically important efforts. However, often overlooked is the impact a streamlined and state of the art Provider Management approach can have on the organization and in driving the tangential benefits of the aforementioned projects. Take the time now to assess whether you are achieving the best possible outcomes.

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The 4 Essential Steps of an Effective Provider Onboarding Program

Julie Peel — Thu, 13 Jun 2013 13:32:00 GMT

In the highly competitive healthcare industry, successfully onboarding a new hire significantly increases revenues, reduces costs, and improves provider relations. For many organizations, their onboarding process includes: recruitment, employment, credentialing, privileging, appointment, and payer enrollment. While each of these steps is dependent on one another, they are often preformed separately, in multiple different departments. The results can be extremely inefficient and costly.

Streamlining the process helps new hires quickly assimilate. This allows them to perform their best as both an individual and as part of a team. It also improves their experience and increases the organization’s retention rate.

However, ensuring effective onboarding isn’t necessarily top of mind for healthcare organizations. Given the potential benefits of a streamlined process, healthcare organizations should strongly consider either developing this competency internally or partnering with a provider management firm to ensure they are using best practices while focusing on their primary objective – providing quality healthcare.

There are four key steps to establishing an effective onboarding program, each of which dramatically impacts the overall process:

Begin at Ground Zero

Successful onboarding does not begin on the new hire's first day. It starts with the recruitment process. Healthcare organizations must first clearly define the type of person needed to fill the open position. Be straightforward about the organization's expectations and culture. The goal is not to get someone who can fill the position. Rather, it is to get the right person for the position.

Have a Pre-Set Path

The onboarding process consists of several steps. It requires the attention of many departments and sometimes multiple employees within each department. One of the most costly facets of the onboarding process is redundancy. An organization must clearly outline each step of the process (i.e. which department is involved, who from the department is involved, and what the goal is) to eliminate redundancy. Creating a pre-set path allows organizations to readily identify areas where redundancy exists, eliminate any overlap, and improve efficiency.

Establish Clear Goals

Ensuring a common understanding of everyone’s roles and responsibilities facilitates a successful long-term working relationship. Outline the new provider’s role, detailing defined and attainable goals to provide focus and direction from the outset of the provider’s relationship with the organization. In addition to managing expectations, this approach also establishes a baseline for downstream evaluation.

Conduct Regular Performance Evaluations

Regular Performance Evaluations play a critical role in supporting open and ongoing dialogue between the provider and the healthcare organization. Performance Evaluations should be based on the responsibilities, and goals outlined during the onboarding process. Effective evaluations should objectively consider the individual’s performance relative to clearly set expectations. By providing regular and timely feedback, new hires can stay focused, improve and drive value for the organization.

The healthcare industry is highly competitive. Increasing revenues, reducing costs, and improving provider relations is the key to success. By implementing world-class onboarding practices, a healthcare organization can maximize its most valuable resource – its providers. To streamline the process and maximize efficiency, organizations need to begin at ground zero, have a clear path and goals, and provide regular feedback. Effective implementation of these key components, whether undertaken internally or with the aid of a provider management partner, will position an organization to recruit and retain top talent within the competitive healthcare marketplace.

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About the Author

Julie Peel is a founding member of the SEERhealth team primarily responsible for developing client strategy and ensuring the delivery of comprehensive, highly successful solutions. Julie has 12 years of experience in the healthcare industry helping a variety of organizations achieve their strategic, operational, and technical objectives. Her strengths lie in strategy formation, program management, business process optimization, functional analysis, and change management. Julie possesses an outstanding record of leading and delivering highly successful business solutions within the public sector, health services, medical staffing, financial services, and high-tech industries. VIEW FULL PROFILE

A Trend in Motion: 6 Benefits of Continuous Credentialing

Matt Gretczko — Wed, 05 Jun 2013 13:32:00 GMT

The market is changing. A recent article in American Medical News, published by the AMA, predicts a decrease in access to primary care by 2014. This trend affirms the need for continuous credentialing as it is likely that other care givers such as Nurse Practitioners, Midwives, and Physician Assistants will take on a more expanded role in the delivery of care to their community. As these individuals take on more responsibility, the scale and complexity of credentialing will only increase. Continuous credentialing will assist in meeting this new demand, but also in reducing provider burden and decreasing cost.

The notion of continuous credentialing seeks to transition the industry from focusing on two-year cycles to instead a constant state of privilegeability for providers. This state would lead to many benefits, including:

Decreased timeframe to grant privileges
Broader ability to deliver care in local, community, and regional areas as the ACO model expands
Lessened burden of credentialing activities on providers, and other resources, through a more balanced and focused effort throughout the year
Alignment and integration of credentialing and privileging activities into the broader onboarding process at the organization, such as FPPE/OPPE and enrollment
Greater information sharing across internal business units
Increased ability to proactively monitor sanctions

Continuous credentialing will cut cost, reduce effort, and relieve resources to help the healthcare industry navigate unprecedented technology innovation, regulatory changes, and market preferences. However, at the basis of this transition is the need to change.

What must change?

People. Process. Technology. You may have heard that combination of phrases before; often delivered by consultants. This does not imply you need consultants to promote and formalize the change. However, it does suggest that your organization must tackle this issue with a formal methodology and approach to ensure that all of the appropriate levers are adjusted to seamlessly incorporate continuous credentialing. This approach will ensure that the results align with the goals.

People

Credentialing affects a lot of people. This is not a bad thing, since the benefits of continuous credentialing are expanding and far reaching. However, organizations must identify the stakeholders that are impacted, which may include the providers themselves, in addition to the resources responsible for performing the credentialing tasks. Once these individuals are identified, you must ensure that the appropriate communication methods are utilized to deliver the process tweaks and outcomes that will result from the new approach. Additional training on the systems that may help automate continuous credentialing will be a critical aspect of the people component.

Process

Credentialing, and the associated verifications, is a process. It has multiple steps that are repeated for each and every provider. In some organizations, these steps are consistent across its various hospitals (where applicable), but in others, there may be tremendous differentiation between them. Prior to implementing continuous credentialing, your organization must confirm a standard set of steps to meet the necessary regulatory and organizational bylaws. Once the basic steps are instituted, then the organization can focus on ensuring that they are able to support continuous credentialing – providers’ credentials will always be at a state of privilegeability and maintained electronically through a system that automates the necessary activities. Often, organizations also institute a shared service model so that all interested business units have easy access to the “data.”

Technology

There is no wiggle room with this one. You must have the appropriate technology to effectively deliver on the outcomes of continuous credentialing. Some of the key features of a worthwhile technology platform are the following:

Workflows for activities
Cloud based/SaaS
Electronic storage of information
Integrated platform – helps address multiple activities in your organization (credentialing, privileging, enrollment, FPPE/OPPE, etc.)
Highly configurable
Handles multiple stakeholders

Organizations with agile infrastructures that can adapt to the changing healthcare landscape will be more successful in attracting the best talent, fostering fruitful relationships with all resources, driving clinical outcomes that lead to higher patient satisfaction, and reducing costs. All of these will continue to be differentiating factors for the best healthcare systems throughout the United States.

Continuous credentialing will be a critical component of this infrastructure.

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The Importance of Big Data in Healthcare

Julie Peel — Fri, 31 May 2013 14:15:00 GMT

As the United States’ healthcare system transitions from a pay-per-service structure to an outcomes-driven payment system under the Affordable Care Act, healthcare providers are going to assume more responsibility for accurately predicting patients’ outcomes. Doctors’ decisions will be based on probabilities determined from historical data that has been aggregated and analyzed, and they will be expected to predict the likelihood of a recovery or a return trip to the hospital. In order to care for patients in this new system, physicians will need access to vast amounts of information, as well as a way to process it. In short, healthcare facilities will need to implement big data solutions so their providers can effectively practice medicine.

Storing Big Data

Over the coming decade, the amount of healthcare-related information will increase exponentially. Some data analysts have predicted a three-fold increase in the quantity of data just in the next four years. This wealth of information will positively impact healthcare in the U.S., as long as healthcare facilities make it available to healthcare providers.

Making big data accessible begins with the storage method. All information should be maintained in a centralized system (although not in the same physical location). This helps researchers and clinical healthcare workers see relationships between the data. If it is segregated into silos, discovering correlations is difficult. By structuring big data in a centralized storage system, though, it is easy to manipulate the data and perform complex analyses.

Using Big Data

Simply storing big data, however, is not enough. This data is not just archived tax documents for the IRS; it contains research and patient information that can help advance medical care. It must be mined effectively to support decision making and improve outcomes.

For hospitals, big data has several benefits. First, it will improve healthcare providers’ abilities to make point-of-care decisions, which, in turn, will lead to lower readmission rates. Second, medical researchers have already benefited from big data. It consolidates formerly segregated information, allowing researchers to identify new correlations. Finally, big data can help improve operational efficiency, as systems are analyzed.

Just as big data has advanced medical research, it must also be used in clinical care to provide a higher level of healthcare. Doctors and other healthcare workers must have access to this information in ways that help them advise patients. If implemented properly, this will lead to better patient outcomes and more effective healthcare delivery systems across the industry.

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The Silver Linings Playbook of Healthcare Technology

Matt Gretczko — Wed, 15 May 2013 13:45:00 GMT

Great Movie. Yes, there is a silver lining out there in all situations, even in the realm of healthcare technology.

Every day, throughout the world, new companies are emerging. To the standard participant in society, the impact and intent of these companies is often ignored unless it directly impacts their lives on a daily basis.

In an article by TechCrunch, Chamath Palihapitiya, a former Facebook executive recently expressed that the quality of new ventures was disappointing– not from a technology or utilization standpoint, but mainly because people are creating alternative or improved versions of current ideas, as opposed to solving problems with new ideas. Mr. Palihapitiya stated that people should be focused on “the big ideas,” especially in specific sectors like healthcare.

The moniker, “Healthcare is Broken,” is no longer helpful in progressing the conversation.

We, as in the collective population of the United States (including all political affiliations, ethnic groups, and financial standings) take this as a given. Therefore, we have reached the point where we need to reach consensus on what the issues are. If we can agree on these, then we may have an opportunity to develop and implement solutions to address the problems.

From my perspective, some of the biggest issues facing healthcare today, which we already have consensus on, are the following:

High admissions rates
Increasing costs
Provider burden
Decreasing patient satisfaction
Lack of information transparency
Lack of technology adoption
Unwillingness or confusion on how to adapt to changing regulations
Disparate data sources
Lack of standardization

Over the past decade or two, the majority of new companies in healthcare did not specifically focus on addressing the problem areas mentioned above. The market often assumed that the big problems can only be solved through regulation, policy, and processes as opposed to new ideas. Therefore, high-profile healthcare technology firms focused their innovation efforts on the development of medical devices to drive more efficient and effective “care.” While this is critically important and must continue, as stated above, we also need to dedicate resources to innovate and create big ideas to solve the issues that also have a broad and profound impact on the healthcare market. This shift has started.

There is a silver lining here…with a playbook that can work.

In order for these companies to succeed, it is critical that healthcare stakeholders effectively illuminate the advantages of their solutions to help drive adoption in the marketplace. This will be the basis for a series of market plays that will fix healthcare.

Areas where companies are finding success in addressing the aforementioned issues are the following:

Cloud Computing

Companies are recognizing that services brought to the healthcare industry must eliminate the intricacies, cost, and complexity of maintaining a complex IT infrastructure. Instead, technology can be hosted in the cloud and drive significant advantages from a flexibility and scalability perspective.

Problem Addressed: Lack of Technology Adoption

Health Plan Selection/Management

A wide variety of companies are developing “marketplaces” whereby individuals and companies can more effectively review, compare, and choose the best health plans for themselves or their employees. Such marketplaces ensure the selection of the right benefit mix at the ideal cost for the consumer.

Problem Addressed: Increasing Cost

Data Tools

Many companies have recognized that the problem in most industries, not excluding healthcare, is not the acquisition of data rather the ability to effectively use it. Therefore, new tools are being imbedded into products to ensure that the right information can be accessed in the right format, at the right time – this includes flexibility, visibility, and adaptability within the growing mobile environment (i.e. smartphones and tablets).

Problem Addressed: Disparate Data

Platforms

Point solutions will eventually be a thing of the past. As cloud computing matures, organizations also want a platform that consolidates a variety of applications/modules to address their business needs without complex integration. This includes coordinating data and processes across multiple business units within an organization to improve its operations, interactions with employees, and relationships with clients (patients).

Problem Addressed: Lack of Technology Adoption

Access to Accurate Diagnosis Information

A major cost in the healthcare market is the unnecessary utilization of services by patients (i.e. going to ERs for a cold). Instead, new technology is being developed to help the patient diagnose issues in advance, with and often without the support of a doctor. For example, applications that allow patients direct access to vetted doctor provided responses to questions. In addition, medical devices that sync local data regarding epidemics, or can track personal symptoms to provide a more accurate assessment of what a patient’s diagnosis may be.

Problem Addressed: Increasing Costs of Care and Decreasing Patient Satisfaction

Doctor Databases

It seems like this is a no brainer, but only recently have companies started to develop robust databases that provide patients with the exact information that they need in order to select a provider. No longer is the address, schooling, and board certification status of a provider acceptable. Patients want to see more detailed quality statistics about a doctor in order to make a more informed decision and regulation tying pay to performance is forcing provides to comply.

Problem Addressed: Increasing Costs and Decreasing Patient Satisfaction

Doctor Concierges

Similar to provider groups, many “boutique” offices are opening that combine the expertise of a variety of specialty providers in one location. The delivery of care is not different; however, for a small fee patients are assured high levels of customer service, immediate appointments, and new methods to openly and effectively communicate with their providers on an ongoing basis – pre, during, and after a visit.

Problem Addressed: Decreasing Patient Satisfaction and Provider Burden

Whether due to overly complex and archaic technology, the inability to effectively manage change, or lack of understanding about the right solutions for the problems healthcare faces, by starting to socialize the technology that is being developed, the marketplace will experience enhanced momentum to fix itself, rather than being engrossed in an ongoing cycle of disarray.

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Background Screening & Credentialing: Similar Disciplines, Notable Differences

Melissa Outlaw — Fri, 10 May 2013 14:33:00 GMT

As a person who spent nearly fifteen years in pre-employment investigations for a top tier provider, Kroll, I’m very familiar with the nuances of the background screening industry. Now that I’ve been in the credentialing world for almost 3 years, I often find myself continually explaining the nuances and disparities between the two. Although similar, there are some distinct differences between background screening and credentialing.

Let's first establish one key point: not all background checks are created equal as not every organization is required to verify everything about an applicant.

A pizza company hiring a delivery person has the flexibility to choose what they feel is important. For example, the pizza company may limit screening to verifying who the person is, if that person has an existing criminal record, and that the applicant has an active driver's license. Some businesses have discretion when it comes to the type of background check they perform; healthcare is indeed different. Healthcare is heavily regulated by state and federal government, requiring specific screening/credentialing prior to bringing a provider on staff.

In comparing background screening and provider credentialing, one can draw the following similarities and differences:

Similarities

Validating the person applying is in fact the person they say they are
Verification of past employment, education, licenses, certifications, references, etc.
Identifying sanctions in licensure, Medicare, Medicaid, etc.
Discovering criminal convictions, civil litigations, and/or bankruptcies
Ensuring that information obtained is from the primary source and it validates provider supplied information
Policies and procedures must adhere to industry rules and regulations

Differences

Generally, background screening is housed in the Human Resource (HR) department, while credentialing is performed in the Medical Staff Office (MSO)
Most organizations only perform background checks upon hiring an applicant. Credentialing must be performed, at a minimum, every two years and must contain quality metrics such as the number of procedures performed, readmission rates, infection rates, average length of stay, mortality rate, etc.
Providers who hold privileges are granted those privileges as part of the credentialing process; and a detailed review of a provider’s education and experience determine what procedures a provider can perform at a facility

After reviewing both processes from beginning to end, it is evident that background screening and credentialing share many of the same concepts, verify the same services, and have a high degree of liability and risk. The initial verification of information is indeed almost identical. The biggest difference arises after the initial verification of information; whereas, the background screening process is complete but credentialing continues in perpetuity, has several more key steps and is coupled with the mandatory two year re-credentialing standard.

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About the Author

Melissa Outlaw is a Founding Partner of SEERhealth and a Senior Vice President with Medkinetics, LLC. Melissa supports clients in benchmarking current internal practices, identifying potential efficiencies then driving the integration of technology with process improvement to reduce time of service and operating expenses. Melissa’s more than 11 years of experience with Kroll managing North American Operations of pre-employment investigations and business intelligence, where much of their business was healthcare related, have been welcomed by our clients in the US and abroad. VIEW FULL PROFILE

Reduce, Reuse, Recycle...Continuous Credentialing

Matt Gretczko — Wed, 17 Apr 2013 13:45:00 GMT

Reduce, Reuse, and Recycle may be one of the oldest and most consistent themes we associate with the ‘green revolution’. Regardless of your political affiliation, over the past 30 years, there has been an intentional and often comprehensive focus on this effort. More importantly though, it is a great example of a mantra that was conceived, instituted, and adopted across an industry.

How can credentialing and quality assurance follow a similar model?

The reality is that the intent and approach to the above mantra align well to one future goal of credentialing – making it continuous. Continuous credentialing will save cost, energy (effort), and resources to help the healthcare industry undergo unprecedented change through technology innovation, regulatory changes, and market preferences.

Let’s further discuss continuous credentialing.

Decreased timeframe to grant privileges
Broader ability to deliver care in local, community, and regional areas as it relates to the ACO model
Lessened burden of credentialing activities for providers, and other resources, through a more balanced and focused effort throughout the year
Alignment and integration of credentialing and privileging activities into the broader onboarding process at the organization
Greater information sharing across internal business units

If we dissect the benefits, they have an eerie alignment to the goals of the “green revolution” as well:

Reduce

From an environmental standpoint, reduction is avoiding the creation of waste in the first place. In credentialing, we can avoid this same waste technically, operationally, and even physically. From a technical standpoint, by implementing and adopting new technology platforms, organizations can have better insight into their organization and thus more appropriately vet providers in advance of moving through the onboarding continuum. If a provider is systematically passed from recruiting to the medical staff office for credentialing, an organization can drive more operational efficiency by leveraging previous information and efforts without restarting the process. From a purely physical standpoint, eliminating the “paper” in the process actually does reduce the environmental waste – clearly not a priority for most healthcare organizations, but if the introduction of new processes has a side benefit, it never hurts.

Reuse

We think of this as purchasing products that can be reused (i.e. coffee mug or water bottle rather than plastic/paper), or repurposing discarded items for a new use. Within the realm of credentialing, once a provider’s credentials have been verified and stored in a system, why wouldn’t they be leveraged by other facilities within your healthcare organization? This would significantly decrease provider burden, reduce the onboarding timeframe, and provide the framework for consolidating these types of activities into a shared service model; a group of dedicated quality assurance experts working to perform activities in an efficient and standardized manner while delivering high customer service to its clients. Unfortunately, many healthcare organizations are not able to avoid an even more simple hassle - the transfer of paper files. Those organizations that have transitioned from paper files still struggle with internal politics and inefficiencies that do not allow the state of a provider’s credentials to be consistent across all facilities. Of course, privileges will still need to be facility specific, but the data utilized to make those decisions should be standardized and shared.

Recycle

We may consider recycling as the process by which objects that are considered waste are brought back to their native components or raw materials, and then used for another purpose. This is when continuous credentialing really comes to fruition. Shouldn’t we be able to break a provider’s record into its raw materials – credentials – and then determine how this information can be recycled for future activities? What if organizations continued to perform their qualitative review of an individual provider holistically, but the tactical processing of credentials and verifications were completed across all providers in a much more efficient manner? A large volume processing capability can leverage an assembly line approach to completing the aforementioned tasks. Both the holistic review, and the processing, occur directly in one system that is capable of driving all activities within the onboarding continuum – recruiting, credentialing, privileging, outcomes, performance reviews, and enrollment. The information, or raw materials, are tweaked and packaged in order to meet the unique demands of each activity. Thus, a large-scale recycling process for data that at all times presents a complete picture of the actual state of a provider, all based upon the appropriate regulatory guidelines and bylaws.

A green revolution may not be occurring in healthcare, but it seems apparent that reduce, reuse, and recycle may be analogous to the goals of some of the main trends in healthcare quality assurance. Healthcare organizations now recognize that a fundamental shift must occur in order to stay competitive while delivering high-quality patient care. The most successful organizations don’t just listen and learn – they step outside the box and seek to employ tactics, lessons learned, and technology from other industries and efforts to build a business case for the desired change. Once the business case is conceived, then the correct resources and strategy can be instituted to be successful.

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New Provider Privileges Require New Evaluations

Melissa Outlaw — Mon, 25 Mar 2013 13:14:00 GMT

In healthcare, one thing is constant - change. It can be a daunting task to keep track of changing policies, yet even more difficult to implement solutions to address those changes! A glimmer of respite in the murky world of healthcare change is a standard that has remained constant like the Focused Professional Practice Evaluation (FPPE). According to The Joint Commission all providers who want to perform a new privilege must have a focused review, period.

Been There, Done That!

Provider history does not exempt a provider from a focused review for a new privilege. It doesn't matter if that provider performed a thousand procedures at a prior organization, helped create the device, and wrote the book on the procedure, they must undergo the review at your facility according to your defined process.

But How?

The standards do allow for flexibility in the way your organization performs the review. Your organization may wish to have direct observation for some procedures, while chart reviews may be better suited for others. Regardless of the how, your organization must have the process clearly defined. It doesn't need to be in the medical staff by-laws or even documented in writing; however, it must be consistently applied to all providers performing the same procedure. Often, organizations leverage technology to define this process and ensure standardization and replication.

Duration or Number

There is also flexibility in whether your organization reviews by duration or by number - as long as it follows a defined process. Some organizations with large procedure volumes may define the competency with a set number of procedures (i.e. must have focused review on fifteen procedures). Whereas some low volume organizations may otherwise decide to review by duration (i.e. must have focused review on all procedures for five months).

New vs. Performance Issue vs. Trigger

In addition to a FPPE policy for when a provider requests new privileges, it is important to define processes for when a focused review is needed due to one of the following reasons:

A provider has a performance issue
A provider triggers a review

Additionally, it is important to ensure that the defined process includes what constitutes a trigger (i.e. sentinel events, complaints, etc.) and what constitutes a performance issue (i.e. returns to surgery, longer length of stays that other providers, etc.).

Having a defined process in place that outlines the criteria for conducting focused professional practice evaluations is a must. How you choose to perform these reviews is discretionary as long as your organization is consistent. Be sure to assess how your organization will handle Ongoing Professional Practice Evaluations (OPPE) on each privilege as it will directly impact your FPPE.

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Three Benefits of Improving the Patient Experience

John Damouni — Tue, 19 Mar 2013 14:00:00 GMT

Improving the patient experience has been among healthcare executives’ top priorities for the last several years. In an effort to infuse further urgency, the government recently instituted Medicare’s Value Based Purchasing program to tie 1% of Medicare payments to patient satisfaction scores. For the first time in history, patient satisfaction is being directly linked to revenue on a national scale.

The benefits of improving the patient experience are manifold and can positively impact multiple areas within a healthcare system. Building a strong service culture that is based on improving the patient experience will assist healthcare systems in improving the following three areas:

Revenue

Customer retention is perhaps the most visible aspect of customer satisfaction. If the customer is not satisfied, he or she simply won’t return; more importantly, the money he or she spent earlier on a business that did not meet expectations will now go to a business that does. Therefore, it is in the interest of every member of the organization to keep the patient satisfied.

One aspect of customer satisfaction that is not easily tracked is the value of customer referrals. It is human nature to listen to others for advice and suggestions, especially from friends, family and colleagues. A patient satisfied with a healthcare organization will recommend it to others they know. This chain will continue to spread as long as patients remain satisfied. All this translates to increased revenue and profitability. Customers and medical personnel will wholeheartedly recommend a facility that they feel provides exemplary service to patients.

Risk Mitigation

According to the National Center for State Courts, the median damages awarded in malpractice lawsuits is $400,000, which is twenty times higher than the median awarded in personal injury lawsuits. While improving an organization’s overall quality assurance practices will inherently lower the probability of medical malpractice, patient experience also plays a considerable role. While malpractice costs are astonishing and will not be fully mitigated by increasing patient satisfaction, if the patient believes that the healthcare provider is genuinely interested in his welfare and all his needs have been taken care of, then even in the occasional case of health complications, the propensity to sue will be considerably lessened. Study after study elicits the clear correlation between time spent with patients and risk of lawsuits. The more time a provider spends with a patient, then the lower the chance of a patient filing a lawsuit.

Talent Retention

In a service industry such as healthcare, employees are an organization’s greatest asset. While a healthcare facility may have the most advanced medical equipment, without skilled and suitably trained staff, achieving service excellence would be difficult. Unfortunately, retaining talented employees is not an easy task even in less than stellar economic climates. Talented individuals thrive on working in an excellence-driven business environment. By nature, service-focused organizations provide an environment that rewards performance, thus appealing to skilled and talented providers and staff. Satisfied providers will naturally promote their organization and recruit additional qualified healthcare professionals, fostering an ecosystem that continuously improves the overall organization.

Improving the patient experience requires more than instituting robust training programs, updating facilities, and tweaking a few standard operating procedures. Improving the patient experience is, at its core, about creating a culture of excellence to promote an unparalleled commitment to providing quality care, measuring results, and continuously raising the bar higher.

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About the Author

John is noted for his expertise in implementing successful customer relationship management processes, as well as developing and sustaining strong client relations teams. VIEW FULL PROFILE

Expanding on the Future of Credentialing - A Deeper Look at the Trends

Matt Gretczko — Wed, 13 Mar 2013 20:26:00 GMT

In my article, the “Art and Future of Credentialing,” I discussed the complexity of credentialing and also emphasized that credentialing must undergo a modernization due to regulation, technology, and the changing landscape of delivering care.

Within healthcare, like any other industry, in order for change and innovation to occur, communication and education must be forefront. Therefore, the intent of this article is to outline in more detail the intricacies of the trends that may help drive the modernization of credentialing.

Credentialing will no longer be largely paper-based

Historically, credentialing has largely been a paper-based process. Healthcare organizations across the country maintain hundreds, and even thousands, of “files” that contain the credentials of their providers. These files (many manila folders) contain copies of source documents, verifications, and a plethora of other materials organized into a variety of sections. Paper files require significant space to maintain, not to mention restrictions on sharing this information with multiple facilities (both within and external to an organization). Moreover, paper files limit an organization’s ability to quickly assess a provider’s credentials, and do not align to the growing need for information sharing and real time analytics.

Moving to an environment in which credentials are stored electronically helps maintain data integrity, promote “continuous” credentialing, and facilitate the sharing of information for credentialing and other activities. Ultimately, regulation will need to provide clarity on what is acceptable as a provider’s credentials as the landscape of healthcare technology shifts towards automation. Rather than maintaining a paper file, it should be acceptable to utilize a systematic, real time view of a provider’s actual information with all the supporting documentation easily accessible as needed.

Credentialing will be one “component” of a broad technology platform

Credentialing is often branded as an administrative burden as opposed to being considered a critical component of a successful onboarding program at an organization. Physician onboarding can be described as the series of sequential processes required to bring a prospective new member of the clinical staff to a fully-functioning and billable state. For most organizations, this involves recruitment, employment, credentialing, privileging, appointment, and payor enrollment

Multiple adjustments can occur to the credentialing process itself in order to decrease the burden and make it more efficient. However, to truly make credentialing an integral component of the onboarding continuum, the aforementioned onboarding activities must be operating on the same technology platform. Too often organizations tend to implement disparate technology solutions that do not integrate with each other which leads to data discrepancies, lack of aggregate analytics, and complex processes to align outcomes across these activities. Instead, by leveraging a platform that provides solutions for each of these components, seamless collaboration can occur across business units. Collaboration will help drive high patient care, improve data access and reporting, increase patient and provider satisfaction, and facilitate proactive risk management – not to mention the elimination of redundant activities regarding data collection. Technology solutions exist in the marketplace today that have various modules to automate these capabilities while also restricting the visibility of certain information based upon roles within an organization.

In order to achieve this operational environment, healthcare executives must analyze the integration points of all initiatives and effectively research options in the marketplace that can meet their needs – this may include expanding or replacing current technologies.

Internal data sharing becomes a reality

If an organization can implement a platform to coordinate activities across the onboarding curriculum, this also leads to another strong benefit – data sharing.

While data sharing is a broad shift in mindset, it has tremendous benefits; especially when it occurs systematically. Not only will the organization develop much more efficient processes and greater visibility of information, but providers will also experience more seamless interactions that eliminate redundancies. Imagine if your organization could consistently derive a holistic picture of a provider in the following manner:

Recruiting shares basic demographics and application information with Human Resources
Human Resources uses this information to vet a provider and then passes this information along to the Medical Staff Office to drive credentialing
The same information is then leveraged to drive privileging and enrollment activities
Privileges granted to a provider are tied to ICD/CPT codes so that all procedures link directly to billing and quality data
Billing and quality data is reviewed and utilized to drive financial processing and focused and ongoing professional performance evaluations
Outcomes and quality data is also utilized to benchmark internally and externally to maintain a competitive edge

Today’s technology can make it a reality.

Continuous credentialing will be the new norm

Today, credentialing generally occurs on a two year cycle. In the near future, healthcare organizations and providers should interact in a symbiotic environment where “perpetual” or “continuous” credentialing is the norm, as opposed to meeting two-year cycles. This means that at any point, a provider would be “privilegable”.

Some of the potential benefits of perpetual credentialing may be:

Decreased timeframe to grant privileges
Broader ability to deliver care in local, community, and regional areas as it relates to the ACO model
Lessened burden of credentialing activities for providers, and other resources, through a more balanced and focused effort throughout the year
Alignment and integration of credentialing and privileging activities into the broader onboarding process at the organization

This notion is further addressed in the article “Promoting the Future of 'Continuous' Credentialing – A Partner in FPPE/OPPE."

Where does that leave us?

Technology innovations in healthcare with the most publicity tend to be those related to devices or procedures. However, there is a growing trend of technologies dedicated to improving healthcare operations by focusing on the ability to drive high patient care, improve data access and reporting, increase patient and provider satisfaction, and facilitate proactive risk management.

These are the technologies we must start promoting and aligning to new processes within our organizations to drive these trends.

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Three Quality Metrics Hospitals Should Communicate to Providers

Melissa Outlaw — Mon, 11 Mar 2013 16:56:00 GMT

Frequent communication between an organization's leaders and their employees is a necessary practice regardless of organization type. Outside of standard operational communications, organizational leaders must also communicate their ongoing strategy to ensure that key stakeholders assist in achieving the desired results – for healthcare, it is maintaining the highest level of care. Within this environment, medical and allied health providers are the stakeholders that play a vital role in how the hospital functions and achieves this goal. Therefore, frequently communicating quality metrics that are focused on improving care results in a win/win for all parties.

Information is Key!

Whether your organization has five providers or 5000, it is important to track and communicate, at a minimum, the following three metrics: Procedures Performed, Provider Benchmarking, and Patient Statistics.

Procedures Performed

Knowing the types and the number of procedures performed is valuable information and beneficial to both the provider and the organization. It allows the provider time to adjust as needed to ensure they are meeting the organization’s minimum qualification for privilege retention. And, if billings do not align to procedures performed/granted it could save the organization time and money. To expedite the gathering of this information, the delineated privileges should be tied to ICD and CPT codes.

Benchmark Data

Benchmarking data displays individual provider performance as well as how they compare to their peers, other providers in their hospital, and if applicable across their health system. Generally, the benchmark metrics consist of the following data points:

Number of Cases
Case Mix Index
Number of Mortalities
Mortality Rate
Number of Readmissions
Readmission Rates
Average Length of Stay

Communicating benchmark data may identify outliers, such as higher readmission rates, which would facilitate conversations to determine cause. The solution may be as simple as prescribing a different antibiotic for the same procedure as other providers – a straightforward change that will improve provider performance, save the organization money and increase patient satisfaction.

Patient Statistics

Reviewing all procedures and understanding each provider's patient demographic and outcomes will help create a complete picture of a provider's performance. Once this picture is understood, communicating this information to providers fosters a collaborative environment between providers and the organization and eliminates the sole focus on events with negative outcomes. This data should include:

Inpatient

Counts by Physician Role (Admitting, Attending, Consultant, Secondary Surgeon, and Surgeon)
Top DRGs as Attending
Top Diagnosis Codes as Attending
Top Inpatient Discharge Statuses as Attending
Top Procedure Codes as Surgeon/Proceduralist
ICD-9 Complication Codes

Outpatient

Counts by Physician Role
Top CPT/HCPCS Procedure Codes as Surgeon/Proceduralist
Top Outpatient Discharge Statuses as Attending

Communicating these three metrics frequently will allow providers to adjust care as necessary resulting in a higher quality of care. And with new laws and regulations surrounding pay for performance and quality of care, hospitals that not only incorporate these metrics into their day to day operations, but also proactively communicate them out to their providers, may ultimately be rewarded with increased revenue and higher reimbursements. Now that’s something to talk about!

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Leveraging QA Shared Services Centers to Streamline Healthcare M&A Activities

Anthony Begando — Fri, 08 Mar 2013 16:07:00 GMT

Your firm spent the better part of a year courting and closing a strategic acquisition in a key metropolitan sub-market. The deal brought three hospitals, five clinics, and an outpatient surgery center into your system. As the deal team encountered a few difficult situations during contract negotiations, once the final terms and conditions were agreed to, all parties sought to close as quickly as possible. Shortly after the plates and glasses were cleared from the closing dinner, the realities of integrating the newly purchased operation and its clinical staff set in.

Three weeks after closing, over 35% of the privileged providers involved in the transaction had yet to complete enrollment with the 26 payers and managed care organizations contracted with your organization. In addition to creating a major disruption in cash flow and potential for lost revenues, this situation also prevented those providers from taking advantage of the more favorable billing terms available under your contracts. Providers themselves were disappointed by what appeared to be a disorganized and poorly planned integration process. Muddled training on systems, procedures, and professional performance evaluation programs directly contributed to a growing chorus of discontent across both the clinical and administrative staff. What had seemed only weeks earlier like an ideal and synergistic business combination was proving to be a major headache for all involved.

Sound familiar?

We have written at length on these pages about the benefits of consolidating and facilitating enterprise-wide quality assurance activities within Shared Services Centers. These operations consolidate a number of historically siloed and disintegrated administrative processes within a highly efficient internal business unit focused on managing provider relations and information from recruitment through retirement. Typically, these activities include initial credentialing, privileging, committee administration, staff appointment, payer enrollment, recredentialing, and facilitation of peer review & FPPE/OPPE programs. Furthermore, these centers can coordinate initial orientation, training, and CME administration for newly hired staff. The information gathered and managed by the center provides detailed, enterprise-wide managerial analytics and simplifies a number of compliance reporting mandates. The benefits stemming from these operations include accelerating new provider onboarding, strengthening provider engagement, and simplifying professional performance evaluation practices. These outcomes directly improve revenue and cash flow while reducing bad debt and redundant administrative costs.

For healthcare organizations currently considering or actively involved in merger and acquisition activities, QA shared services centers can play an integral role in catalyzing deal flow and ensuring successful integration processes. By working directly with deal and integration teams, service centers can facilitate clinical staff alignment, credentialing, privileging, and payer enrollment activities well in advance of closing to ensure “Day 1” readiness for staff-wide appointment and reimbursement. Furthermore, the services center staff can provide consultative support to several key, but often overlooked integration activities such as QA policy harmonization, systems integration, risk management analytics, FPPE/OPPE transition, accreditation compliance & audit readiness, and compliance reporting continuity. Finally, by leveraging the services center’s intrinsic onboarding function, acquirers can expect new staff members to experience a well planned, efficient, and highly professional introduction to their new parent organization.

To learn more about best practices for developing a QA shared services center, please follow the link below.

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About the Author

Anthony Begando is the Co-founder and Chief Executive Officer of SEERhealth LLC. Anthony has 21 years of experience in the healthcare industry. Since 1995, he has held leadership positions within the healthcare field, as well as founded Tenon Consulting Solutions, Inc. and Military Credentialing Solutions, Inc. and is noted for providing practical, creative solutions that improve business performance. VIEW FULL PROFILE

Promoting the Future of "Continuous" Credentialing - A Partner in FPPE/OPPE

Matt Gretczko — Thu, 07 Mar 2013 16:43:00 GMT

I am a firm believer that within the next 3-5 years credentialing may follow less of a “two year cycle” and instead will seek to achieve “continuous” or “perpetual” credentialing – a state which allows a provider’s credentials to be fully up to date at all times, or completely privilegeable. This may seem like a big leap, but the reality is recent factors, some of which are outlined below, are actually supporting this trend. Unfortunately, gaps in communication and collaboration within the healthcare market often restrict the transparency of such benefits.

The institution of FPPE/OPPE reporting and process requirements supports perpetual credentialing

These two evaluation requirements help ensure that a provider is competent to perform the procedures and tasks they have been assigned within a particular institution. Whereas FPPE is a defined duration, OPPE is a defined frequency. According to a presentation by Harvard Medical School, OPPE is defined as: “Measurement of physician performance data to assess competency and approve privileges on an on-going, non-periodic basis to allow them to take steps to improve performance on a timelier basis.” In my application of that definition, if an organization is performing ongoing reviews (more than once a year) of a provider’s performance and competencies, it would make sense to also ensure that the provider’s credentials which support those capabilities are also maintained throughout the year. Moreover, FPPE drives a similar goal in that it is triggered when a provider is initially granted privileges, receives new privileges, or exceeds an OPPE threshold. At these points in time, wouldn’t you want credentials that are up to date and fully referenceable as well? Forcing institutions to institute processes, and hopefully technology, to drive these evaluations aligns to a vision of having a perpetual privilegeable state for a provider.

Technology is the catalyst for effortless data maintenance

In the past, most healthcare organizations stored their credentials information in paper files. Although many have transitioned to systems that help “maintain” this same information electronically, the reality is they still may not be leveraging these automated systems to fully replace paper documentation (i.e. view electronic information in place of an actual credentials file). This transition will take time and also requires regulatory changes. However, the ability for these systems to streamline data entry and more effectively store credentials information and the associated documentation, also provides a better mechanism for credentials maintenance. In addition, these systems can help drive two key areas of analytics – operational (completing the credentialing and verification work), and outcomes/quality (understanding the performance of individuals within your organization). Instituting policies and programs, whereby providers inherently seek to update their information as soon as a change occurs, or are notified when expired documentation is due, will also help drive this state of perpetual credentialing.

What are the benefits of perpetual credentialing?

Some of the potential benefits of perpetual credentialing may be:

Decreased timeframe to grant privileges
Broader ability to deliver care in local, community, and regional areas as it relates to the ACO model
Lessened burden of credentialing activities for providers, and other resources, through a more balanced and focused effort throughout the year
Alignment and integration of credentialing and privileging activities into the broader onboarding process at the organization

It is important that as organizations institute FPPE/OPPE processes and technology to drive it, these same organizations recognize the inherent tangential value of such policies, such as reshaping the manner in which credentialing is performed. In addition, the healthcare environment must continue to look towards other impending changes and determine how they may also drive new trends within the healthcare environment.

Of course, there are still challenges. One of the main ones being that regulatory bodies will ultimately need to collaborate with organizations to understand the trends and goals that their policies must seek to promote at market level scale.

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Patient Experience: Exceeding the Patient’s Expectations

John Damouni — Fri, 22 Feb 2013 14:02:00 GMT

The challenges of providing patients with a “positive experience” in healthcare are undeniable. Most healthcare organizations work hard to meet the basic level of service standards demanded by their patients, governmental regulations, and the marketplace. However, when it comes to patient experience, the difference between meeting the basic level of service, and delivering great, or even excellent service can be vast. Nevertheless, the patient experience can be improved by making simple changes to the current service delivery model in healthcare organizations.

While it is virtually impossible to exceed all patients’ expectations, most patients expect healthcare organizations to be clean, rooms to be comfortable, and providers to be competent. However, even when these basic expectations are met, the ability to satisfy patients’ concerns can determine whether a patient has a positive or negative experience at a hospital. Some of the common patient complaints include wait time, responsiveness of a timely manner of staff, and poor communication. Process redesign, rigorous employee selection processes, and intensive training programs are a few of the tactics utilized to combat some of the service symptoms patients experience.

The level of service delivery that healthcare organizations should strive for is exceeding expectations. In order to operate at this level, healthcare executives must make the following strategic objectives a top priority:

Create a culture of service; including strong service-oriented mission and vision statements
Select and recruit service-driven providers and healthcare professionals
Create an ongoing training program to support the changing needs of patients
Measure and evaluate service performance to continuously refine offerings

Once the aforementioned objectives are realized, the appropriate service infrastructure will be in place to drive a state-of-the-art service model. At this level of service standard, patients can expect that all interactions with healthcare professionals and the organization demonstrates a strong mission to deliver high quality service at each step in a patient’s wellness journey. Some of the noticeable enhancements patients would be able to discern include:

Personal Care

Patients will receive personalized care from empathetic providers and staff who are emotionally connected to patients’ concerns.

Anticipation of Needs

Healthcare organizations striving to exceed patients’ expectations are led by providers and staff who can “sense and respond” before being asked or prompted. The ability to anticipate needs will comfort patients and build trust and credibility quickly. Examples of anticipation of needs may include responding to non-verbal signs a patient has pain or discomfort, or perhaps body-language cues exhibiting frustration with wait-times for a particular service.

Family Engagement

One of the most glaring differences between healthcare and other service-oriented industries is family involvement. Frequent and consistent communication with family members can assist with easing a stressful experience. Furthermore, involving family members in the recovery process alleviates patient and family stress and enhances the chances of a speedy recovery.

Healthcare systems working to exceed their patients’ expectations understand the long term benefits to the patient and organization are manifold. Cutting-edge healthcare organizations start every initiative with the end (the patient) in mind. By building a culture of service, organizations would inherently improve the quality of care delivered, mitigate risk areas, retain talented individuals, and improve processes and procedures to increase operational efficiencies.

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Credentialing Without Borders

Matt Gretczko — Wed, 20 Feb 2013 20:50:00 GMT

Innovation and collaboration is at the heart of what we do at SEERhealth. In order to achieve these goals, we invest a large amount of time to become “experts” in the healthcare market. This dedication allows sufficient competency to drive the solutions, change, and thought leadership that we believe can define the future of the marketplace. Our team also recognizes that the many intricacies and components of the healthcare industry ensure that being an expert on all of its facets is impossible.

But what if we could examine one critical component of healthcare at a time and start to address it globally – and when I say globally, I mean globally.

In most industries, organizations tend to focus their attention on certain “markets.” They start rolling out a product or service regionally, then nationally, and maybe even internationally. As this expansion occurs, the products and/or services tend to evolve to meet the varying demands of it's customers. Some of this evolution is driven by revolutionary ideas, but the process is typically driven by a market need.

What if we were to think about credentialing as this type of need? Products designed to address issues in the United States could then be leveraged to drive efficiencies elsewhere – and maybe even vice versa.

In attending domestic healthcare conferences, one of the more noticeable non-topical themes is that international participation continues to grow – this includes attendees from Canada, Brazil, India, some Middle Eastern nations, and many other countries. Some may argue that this international presence is because the United States truly offers some of the best care in the world and other nations are trying to mimic it. Others may say it is to learn from our mistakes. Both may be true as we know the U.S. healthcare system is front and center with debate. What I do know is that this trend of participation is because many aspects of healthcare, domestic and foreign, are the same – not excluding credentialing.

Credentialing is global.

One of the most critically important yet negatively branded activities within the provider onboarding continuum is the process of credentialing. Credentialing is the process by which a provider’s skills, education, and training are verified. At this native level, credentialing is the same no matter where you practice in the world. Unfortunately, as an industry, healthcare has not yet capitalized on the similarities of the outcomes and instead focuses on the process intricacies that lead to differentiation.

Take Canada for example – they have alternative regulatory bodies that govern the appropriate skills, education and training that a provider must have, they have unique payment methods due to their institution of national healthcare, and they have differing semantics for aspects of the process (even for providers themselves). However, the reality is that the resources responsible for performing credentialing in Canada, similar to the United States and many other countries, seek to ensure that they have providers who are competent to deliver the highest level of care to patients.

Focusing on the niche problem of credentialing, we can build dynamic technology that allows organizations to effectively vet a provider, but tweak the steps and approach to reach that goal based upon the standards and regulations of their country. As credentialing continues to evolve it will become part of a broad platform that drives the sharing of quality and outcomes data to build an integrated model of risk management (See – art and future of credentialing). Healthcare should not be held to physical barriers when there is enormous opportunity for collaboration and innovation across borders to drive efficiency and improvement.

Credentialing is one small, but key component that can help be a catalyst for this change in redefining how high patient care is delivered. We hope our solutions, and others, can make this a reality.

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[VIDEO] What is a Shared Services Center?

Anthony Begando — Thu, 14 Feb 2013 19:47:00 GMT

<00:00>	Hello, this is Anthony Begando with SEERhealth Corporation. Shared services centers is a concept that was developed about forty years ago in the industry to help large organizations consolidate functions that were typically being performed across multiple locations or divisions or subsidiaries or what have you in a common corporation or enterprise. The idea was, you could take a common function like human resources, personnel services, information technology,
<00:30>	logistics, supply etc. and build one organization that would provide and support those common functions to all members of an enterprise. Shared services have been a little slow to catch hold in healthcare, however over the last ten or fifteen years we have certainly seen IT and HR applications being utilized around shared services. One area, that we at SEERhealth, have been working hard to implement and been quite successful in implementing involves consolidating quality assurance practices
<01:00>	for providers that would typically involve the functions related to credentialing, privileging, committee and appointment processes, payor enrollment programs and also, performance monitoring and professional performance evaluation programs. Collectively, this sort of continuum of activities helps an organization truly manage their relationship that they have with their healthcare providers and clinical staff.
<01:30>	Within a healthcare organization, putting a quality assurance shared services center in place really can drive out several significant, short-term and compelling benefits. Fore mostly, provider onboarding, whether that’s your new hires, acquisitions, post-residency or fellowship employment situations and what have you, can be greatly simplified, supporting things like
<02:00>	multi-facility appointments, core privileging etc. With regard to onboarding and payor enrollment, simplifying and speeding up that enrollment life cycle in order to improve revenue recognition for new hires and finally, improving the relationships that exist between the healthcare organizations and the clinical work staff.
<02:30>	Simply stated, a well run shared services center helps providers make it easier to do business and work with a healthcare organization. This has been Anthony Begando with SEERhealth. If you’d like to learn more about how we may be able to assist your organization in developing a shared services center for quality assurance please feel free to contact us directly. Have a great day.
<02:42>	END

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Healthcare Continues to Benefit from Shared Services

Melissa Outlaw — Tue, 12 Feb 2013 15:29:00 GMT

In today's ever changing world of healthcare, there is an increased number of multi-facility organizations. It is the norm, especially with the expanding emphasis on ACOs, for an organization to encompass a mixture of hospitals, surgery centers, physician practices, and long-term facilities. Due to this environment, we are also seeing a fundamental shift in how these organizations collaborate to manage the credentialing of providers. This has resulted in significant benefits for both the organization and providers.

This is 'shared services' - identifying the services that are repeated at each or multiple facilities and then consolidating them into one, central location. Most are familiar with the centralization of Internet Technology (IT), and Human Resources (HR). Both HR and IT underwent a significant shift from being separate business units at multiple facilities to a single entity that performed activities for the entire organization. It has now become not only standard, but accepted as the most effective way to run a business.

Medical Staff Services - Shared?

Healthcare has now reached the point in which Medical Staff Services is being consolidated in order to eliminate redundancies across the organization. Verifying providers' credentials information in a central location not only allows large organizations greater efficiency through volume-based processing, but it also leads to greater sharing of information, higher visibility of key data and statistics, and creates an office within healthcare that drives best practices throughout the organization.

Provider Satisfaction - Win/Win!

As the creation of a centralized credentialing office becomes conventional, organizations will see a direct impact on provider satisfaction. Before, if a provider worked in three facilities, he or she would go through credentialing three separate times. This means the provider would have to review and update his or her information, and provide copies of all updated information, three separate times to three different medical staff personnel. Consolidating all this work to be completed only once and establishing one point of contact for the provider will eliminate excessive paperwork and allow the provider to do what he or she does best - see patients. Ultimately, this is a win-win for the organization and the provider.

Careful Consideration is Necessary...

It is important to note that the centralization of services, such as credentialing, does not mean that facilities are no longer supported. In fact, it is often commonplace to maintain some staff members, depending on the size of the organization, on-site to help facilitate tasks that are facility-specific, like privileging.

The shared service model has demonstrable positive results for both organizations and providers. However, it is important to do it accurately and methodically. If you do not have staff experienced in large organizational change initiatives and knowledge of the variety of factors that must be considered to create this solution, we recommend that you look outside your organization to help oversee this effort.

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Improving Patient Experience with Personalized Service

John Damouni — Sat, 09 Feb 2013 14:21:00 GMT

No doubt you have interacted with a warm and engaging healthcare provider that has impressed you with their advanced emotional intelligence skills, and was successful at establishing a strong brand perception for the organization they represented. While it may be obvious to service advocates in the healthcare industry that “service” is the primary objective of healthcare providers, how that service is delivered is what differentiates good healthcare providers from great healthcare providers.

The way in which a service is delivered can be just as important as the service itself. Take for example two different healthcare providers who can sense a patient’s fear of a certain procedure and take different approaches to easing the patient’s concerns. The first decides to go into details about the procedure, often speaking in complex medical terms that the patient cannot comprehend. The other, more empathetic, healthcare provider takes the time to communicate comforting and reassuring words to ease the patient’s concerns. To the patient, the actual medical service remains the same, but the experience is positively altered with the guidance of the more empathetic provider.

Industry leading healthcare organizations train their employees to personalize the delivery of a service based on the perceived preferences of a client. In order to properly “sense” an individual’s preference for service delivery method in healthcare, one must be able to watch for verbal and nonverbal cues, including:

Engagement level:

Healthcare providers should be able to detect a patient’s level of engagement and adjust their approach accordingly. Some patients may be hungry for information and want to be involved in the course of treatment, while others prefer to be comforted and assured of a quick recovery. Providers must be able to tailor and personalize their service approach to successfully meet every patient’s expectation

Body Language:

Most communication experts claim that over 90% of communication is non-verbal. Therefore, in order to personalize the delivery of healthcare related services, healthcare organizations must select and train healthcare professionals with high empathy, relationship-building, and emotional intelligence skills

Credibility and Competence:

Patients in need of care are often vulnerable and uncertain about their course of treatment. Behavioral cues can reveal someone’s degree of fear, uncertainty and doubt. Healthcare providers must be able to build a strong bond with patients leveraging their competence and experience in the medical field

The most successful healthcare organizations foster a work environment where providers and healthcare professionals are empowered to own and nurture personalized relationships with patients. In the current competitive landscape of the healthcare industry, personalized service delivery can be a strong differentiator that can separate the good healthcare systems from the great healthcare systems.

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John is noted for his expertise in implementing successful customer relationship management processes, as well as developing and sustaining strong client relations teams. VIEW FULL PROFILE