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Joe PolarisJune 21, 2021

MGMA Takeaways: Transforming Care Coordination and RCM

MGMA Presentation Takeaways for Patient Experience

At the recent MGMA Medical Practice Excellence Pathways Conference, Sherri Harris, Regional Manager of Scheduling for Ascension Sacred Heart and Joe Polaris, SVP, Product and Technology for R1 RCM discussed ways to transform the care coordination and revenue cycle journey for patients and referring providers. Knowing today’s patients and referring providers expect a convenient and streamlined experience, Ascension Sacred Heart developed a plan to offer end-to-end digitization for both key constituents. The new experience leverages digital self-service for patients and rules-based logic and workflow management to reduce manual work and intervention by staff – transforming tasks that were formerly complex, such as prior authorization; highly manual, such as order management and scheduling; or simply inconvenient, such as registration. Here are four key takeaways:

 

  1. Digitize and Integrate Orders, Prior Authorizations and Scheduling. Ascension Sacred Heart sought to eliminate the common bottlenecks and sources of frustration for patient access teams, referring physicians and patients, such as lost paper orders, prior authorization delays, costly last-minute reschedules and numerous phone calls. By implementing standardized and optimized processes across facilities, enabled by intelligent rules-based technology, they gained high adoption by their providers for electronic orders, automated prior authorization processing and guided scheduling for diagnostic and treatment services. These technology-enabled processes have held scheduling error rates to 1% for six years and improved the speed and reliability of prior authorizations. From the patient and provider perspective, these two major causes of last-minute reschedules and care delays have been reduced dramatically. For the health system, that means not only higher volumes, but also more reliable utilization so that high-value clinicians and equipment are not left idle when empty slots can’t be filled.
  2. Give Referring Providers Care Coordination Tools. Ascension had a vision to strengthen relationships with its network of employed and independent providers. To make it easy for providers, they wanted to move from a 'manual appointment request/follow-up call’ model to a digital ‘order-first or schedule-first’ model – ensuring patients never leave a care setting without next steps in hand. For example, when a patient needs diagnostic imaging, the physician can choose to send the electronic order first or start by scheduling their patient directly at the health system, in real time. With either approach, the health system immediately receives an accurate, complete order. Behind the scenes, automated rules confirm when a prior authorization is required by the payer and obtain it quickly and efficiently to eliminate care delays. At the same time, the physician office can schedule the patient for a follow-up visit to review results. The outcome is that patients and their families leave their physician’s office with peace of mind that everything is set up and ready to go, with no need to worry about making phone calls or tracking down insurance authorization.
  3. Actively Collaborate with Referring Providers. The care coordination process only works if providers are willing to use it, which is a challenge for many health systems. Ascension worked closely with their physician community to make sure the digital tools supported their workflows. They enlisted physician liaisons to provide in-person/virtual training and resources and utilize feedback from those sessions to adjust workflows for the best possible experience for providers and their staff. For example, they created templates for their most frequently ordered services to make it even faster and easier to submit electronic orders. By giving providers easy-to-use tools and flexibility to order first or schedule first, Ascension has gained 30% adoption of these tools, resulting in stronger relationships between the health system and both employed and independent providers in the community – and an increase in market share.
  4. Expand Online Patient Self-Service. With streamlined digital processes and tools that have high adoption rates among their physician community, Ascension is looking ahead to use this technology to accelerate and expand patient self-service, especially for high-value service lines like imaging. Understanding the complexity of clinical scheduling, having rules-based technology that guides patients step-by-step to schedule their appointment will remove the guesswork and reduce the potential for errors. With this approach, once an order and any necessary prior authorization are received, they will be able to send a personalized message and link – with all the clinical requirements included – to the patient to self-schedule their appointment according to their preferences for date, time and location. Once booked, the patient will then be able to pre-register in advance by reviewing or updating current demographic and insurance information, filling out forms and making their payment – all at their convenience using their own device.

Ascension Sacred Heart has seen significant gains. They have achieved an 80% increase in orders from referring providers, going from an average of 5,000 to 9,000 monthly, which are then efficiently converted to scheduled procedures. At the same time, they have reduced call times by 70%, as well as lowered costs associated with staff training and turnover.

 

By transforming the care coordination and revenue cycle journey, Ascension Sacred Heart has given patient access teams and referring providers tools to work smarter, while driving meaningful KPI improvements. And by building stronger physician relationships and enabling better care coordination, they are increasing patient satisfaction and loyalty.



Author Bio: As R1 RCM’s Senior Vice President of Product and Technology, Joe Polaris leads the company’s product strategy development and roadmap execution. He has been with R1 RCM for more than 13 years and has developed deep front-line revenue cycle expertise holding positions such as Revenue Cycle Site Lead and Director of Operations, where he built innovative end-to-end processes that have increased the financial stability for hospitals and health systems.