October 2019: The importance of standardizing administrative tasks

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October Insights: The importance of standardizing administrative tasks

by Christine Murphy, Vice President of Network Management

Murphy_onboardingThe dot-com bubble of the late 90’s was a watershed period during which investment in new web companies spiraled out of control and, as the name implies, eventually burst. During that time, I was working in high-tech and had the luck (good or bad?) to be in the thick of things in Silicon Valley. Though I’ve been in the health insurance business for nine years now, I frequently think – and speak – about my Silicon Valley days for a couple of reasons. First, it was a master class in how not to innovate (key takeaway: just because it’s new, doesn’t mean it’s better), and I never want to lose sight of what I learned. Second, process automation and streamlining consumed a lot of my time and thinking in those years, and it consumes a fair amount of my time and thinking today.

Over the past year, I’ve had the opportunity to meet with many of you, and a common theme in our conversations is that benefit structure, provider operations, and myriad contract obligations, combined with health plan operations create a collective administrative burden that’s increasingly unsustainable. Our industry is complex, there’s no getting around that, which means that our systems and processes are necessarily complex too. But instead of settling for the status quo, we must redouble our efforts to streamline, simplify, and reduce redundancy wherever possible. In a game of inches, every win makes a difference.

Many unnecessarily burdensome administrative tasks are related to enrolling and maintaining the data integrity around providers, a set of tasks knows as "roster reconciliation." A 2018 report from CMS found that found that 52.20% of provider directory locations listed had at least one inaccuracy. A study sponsored by the Commonwealth Fund showed that Google – not "official" provider directories – was the most reliable source of provider information.

These studies and others acknowledge the complexity of the situation. Data integrity is everybody’s problem. Payers, providers, and regulatory bodies all need to look at ways they can contribute to a solution.

Here at Allways Health Partners we are using technology and process automation to address accuracy of provider data, and we are accordingly making some changes. In the past, we’ve been undisciplined in the way we intake information from providers about providers. We’ve accepted change by email, verbally over the phone, and in the AllWays Health Partners provider portal. These multiple entries into the AllWays Health Partners organization has prevented us from imposing any standards or efficiencies on provider data intake and reconciliation; moving forward, we will be more consistent about how we receive and reconcile provider information.

There’s a certain amount of pain inherent in standardizing a process. However, if we don’t standardize, we can’t automate, we can’t establish standards for turnaround time, and we can’t manage to a goal.

In coming weeks, you’ll see notifications in the newsletter and in our blog, describing how we’re changing how we receive this information. One of the first changes will be in how we ask providers to submit rosters and roster changes. These changes will streamline and speed up provider enrollment, and will ultimately lead to cleaner data and better provider directory information.



Tip of the month: Health and wellness campaigns

We are starting multiple health promotion and disease prevention campaigns in October to our AllWays Health Partners members. What makes us different is that all of the messages and resources are being provided via text to our member’s mobile phones. We appreciate any support you can provide as we educate members in the areas of asthma medication management, anti-depressant medication management, diabetes care, and general health and wellness with a particular focus on women’s health. Read more about the program. We also offer health coaching, care management and Partners on Demand, among other services.



In case you missed it: Top content for doctors and clinicians in September

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In this active year for EEE, make sure you know these three facts.

The doctor is in (my news feed): Patients are using social media to find a doctor
The Healthcare Consumer Insight & Digital Engagement survey from Binary Fountain contains various key findings, including that over half of consumers use social media to find doctors.

Questions about your health? Text yes or no
We're reaching out to members via text to give them the information they need to be healthier.

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