Situation 

When faced with the challenges arising in the era of value-based care models, many healthcare organizations are reorganizing into Clinical Integration Networks (CINs).  A CIN is a legal and organizational designation, grouping primary care and specialty providers with hospital organizations and post-acute facilities. The goal of this organizational alignment is  better  coordination of care across all patient care settings and reduction of operating costs of care delivery. Prominence worked with a large hospital delivery network as they started on this journey, specifically, to advise and manage the combination of physician, hospital and FQHC billing offices.

Task

In order to successfully facilitate the combination of billing for a new network of providers and facilities, there were a number of foundational tasks we had to tackle including:

• Defining billing office staffing numbers
• Realigning staff to support organizational recommendation
• Defining roles and responsibilities
• Evaluating outsourcing of billing office operations
• Conducting 3rd party vendor evaluation and selection
• Training management on new workflows
• Conducting alignment sessions between business office management and clinical leadership
• Conducting alignment sessions between business office management and county fiscal leadership
• Gathering KPIs to monitor prior and post implementation

Action

During this 18-month engagement:

• Decisions were made to not outsource billing functions but instead staff up to support the various new billing office responsibilities
  • As a result, analysts were promoted to supervisory positions, managers, directors and new employees were hired to manage the new range of tasks and responsibilities
• 3rd party vendors were evaluated and selected
• A model for shared division of labor between current billing offices and outsourced agency was developed
• Analysts and managers were trained on new workflows
• Governance and communication paths were established
  • Aiding in integrated discussions with clinical and county leadership
  • Resulting in the insertion of bonus incentives for clinicians to meet revenue cycle impacting metrics, such as closing encounters to trigger charges

Result

As a result of the many new structures and EMR build, the customer went live with non-hospital based clinics in August and hospital based clinics in October. The groups are all successfully monitoring KPIs and communicating KPI progress out to the rest of the organization, holding physicians accountable for revenue impacting metrics and setting goals and plans for where they would like to improve and hire.  They are basing these decisions on data and metrics they previously couldn’t access.