Evolution of a system wide cvo WAMSS Meeting – walla walla, wa – april 26, 2017

objectives Understand the set-up and organization of a Health System CVO Understand how a CVO benefits your hospital/health system Understand how bringing Provider Enrollment into your Credentialing world is a beneficial Understand the importance of having a single source of truth database Understand how to set-up and implement quality monitoring, matrix and reporting in your credentialing and provider enrollment processes

St. Luke’s health system 8 Hospitals (9th opening 10/2017) 1 Rehab Hospital 5 Surgery Centers 2 Urgent Care Centers 5 Tumor Institute sites 280+ Clinics 2 Managed/Partner Hospitals Statewide Provider Network 5,589 Providers St. Luke’s health system Idaho’s Largest Locally Owned Health System

Why centralize & standardize? Credentialing is expensive Credentialing is time consuming Lots of duplication Long & varying turnaround times Frustrated providers, physician services, administration

benefits TO FACILITIES TO PROVIDERS TO MSSPs More time to .. Update Bylaws & documents Develop policies Improve meeting preparation & follow-up Assist Medical Staff Leadership Increased efficiency Increased regulatory compliance Audit Ready Files Cost savings Increased productivity Elimination of duplication Streamlined processes Increased efficiency Increased accuracy Increased regulatory compliance ONE application & forms Standardized requirements Shorter processing times One source of truth – record documentation Dedicated coordinator Provider Enrollment & Credentialing done simultaneously

Cvo creation CVO was created in 2010 Expanded Services Rapidly grew 2,472 providers 5 staff members 4 Hospitals Credentialing Only Expanded Services Provider Enrollment (2011) Database Management and Single Source of Truth (2012) Rapidly grew

CVO Current day & Organization 14 Employees Numerous Facilities 3 Services Lines: Credentialing (5,589 providers) Database Management (14,646) Provider Enrollment (1,376 providers)

credentialing Initial Appointment Reappointment Sending the application through verification Reappointment Specialty cycle alignment Expirable Management (10,372 annually) Notices 60 days prior & Follow-up Ongoing Monthly Monitoring Privilege Maintenance Delegated Credentialing Audits Audit Help & Assistance

PROVIDER ENROLLMENT What is Provider Enrollment? The overall process of gathering credentials information, completing payer applications, obtaining signatures, submitting applications to payers, verifying enrollment effective dates and maintaining the enrollments. Why doing it well matters Faster enrollments mean faster reimbursement Less denials & write-offs mean more money Benefits of including it in your credentialing process One stop shopping Seemless process Less ‘hands in the pot’ Initial Enrollment Recredentialing Out-of State Medicaid, Railroad Medicare, Workers Comp Enrollments Maintenance: Changes Claim Resolution Terms

Database management - SINGLE SOURCE OF TRUTH Maintains a complete provider database Credentialed, referring, ordering Provides system-wide reports, directories, exports Exports to all downstream systems including EPIC Credentialing database support Automated forms, letters, reports, emails, faxes, processes Standard workflows Provides Software Training Troubleshooting Builds reports, letters, forms, modules Prior to Single Source of Truth Numerous provider databases Data integrity was non-existent Confusion & frustration Benefits of being the single source of truth Increased data integrity One place to provide updates One place to request data/reports Happier customers all around

successes Improved Turnaround Times Faster Enrollment with Payors – MORE $$ Less claim denials and deactivations Audit Ready Files Increased compliance with regulatory standards Increased Provider & MSSP Satisfaction Decreased costs Zero expired documents Online Application & Privileges Paperless credentialing files Aligned reappointments Improved data integrity

OUR QUALITY PROGRAM Monthly Monitoring & Reporting 100% File Review Activity Numbers Turnaround Times Credentialing & Provider Enrollment Errors & Omissions Provider Satisfaction Initial & Recredentialing Client Satisfaction Billing Hold Dollars Controllable Write-offs: Enrollment 100% File Review Quality Reporting Tool Database Audits Written Standard Operating Policies Individual Coordinator Feedback Reports Quarterly & Yearly Quality Report Sent out & shared throughout system

Sample of quality scorecards

System Peer Review/OPPE/FPPE Processes What’s in our future System Bylaws System Privileges System Peer Review/OPPE/FPPE Processes One System Credentials Committee

Tawna Miles-Knight, CPCS. CVO Director st Tawna Miles-Knight, CPCS CVO Director st. luke’s health system – Boise, ID milest@slhs.org (208) 381-8744