“Engage & Change: A Health System CVO’s Approach” 04/01/2019 | Candace Gwizdalski, RN, BSN, MA, CPMSM, CPCS Monica Muralles, CPCS Dolores Rivera, CPCS

Who we are… Legacy Advocate Health Care Fully integrated multi-facility health care delivery system 11 Hospitals, 3 Medical Groups 7,000+ medical staff 1,600+ advanced practice clinicians (APRN, PA) and psychologists 11 PHOs 6,100+ members Merged with Aurora Health Care 04/2018 Additional 16 hospitals; and 4,500+ practitioners

Department Structure… Center for Practitioner Information (CPI), 1997 NCQA Certified CVO, 2000 Management team (Director, Manager, Supervisor Managed Care) Lead coordinators (2) Credentials coordinators (10) Managed Care Credentialing coordinators (5) Provider Enrollment coordinators (5) Data analysts (2) Quality coordinators (2)

The start of our journey… New leadership Restructured teams and roles Integration of provider enrollment Opportunity to streamline processes Communication gaps Partnership building Learning needs

Provider Enrollment Wins… Developed Provider Enrollment electronic process Ability to track status Quality metrics Visibility of status to other teams Eliminated redundant work tasks Out of scope functions Reduced financial losses perceived as credentialing write-offs

Process Wins… One point of contact (primary site) Standardized and reduced the number of documents sent with the application Primary source verification elements Reduced size of evaluative letters and forms (four to two pages) Established criteria to better utilize AMA profile Use of AMA profile with parameters – use for training greater than two years ago (if within two years, evaluations are required)

Decreased minimum number of competency requirements Goal is to obtain two completed evaluative documents for competency in preference of: Current Hospital Recent Training Personal Peers Clinical Work History

Communication: “Prospect” information for entry into database Sections: Practitioner demographics Board certification status Dept/Section Site(s) and privileges Requested Employed/Non-Employed Group name and info

Communication Practitioner Credentialing Status

Our continued journey…Change "The only person who likes change is a baby with a wet diaper” Unknown Mark Twain? “Insanity: doing the same thing over and over again and expecting different results.” - Albert Einstein

Our continued journey…Change “The only thing that is constant is change.” Heraclitus, Greek philosopher “Be the change that you wish to see in the world.” - Mahatma Gandhi “Yesterday I was clever, so I wanted to change the world. Today I am wise, so I am changing myself.” - Rumi, 13th century poet

Change Management Variety of change management models Explore and adopt what is valuable and meaningful to you, the situation and your organization Value in using a structured plan

Change Management: Key concepts Identify need for change Where you are and where you want to go Current state Future state

Develop the plan: Things to consider Internal factors Availability of resources – financial, people, technology, physical space Organizational fit - values, culture, goals Current and future performance Readiness

Develop the plan: Things to consider External factors Regulatory and accreditation Legal Political Social

Develop the plan: Engage stakeholders Impacted or interested individuals/groups Your team Other teams and departments Practitioners Payors Patients, families and communities Engage early and/or keep informed Consider their requirements

Develop the plan: Risks and opportunities Determine low, medium, high impact/severity Informal analysis for low risk Formal analysis for medium or high risk Tools: gap analysis, failure modes and effects analysis (FMEA), root cause analysis, or strengths, weaknesses, opportunities, and threats (SWOT) and more… Utilize to make informed decisions Addressing and lessening risk Pursuing the opportunities

Develop the plan: Knowledge Assess existing knowledge to implement and support change Plan to address gaps – education, tools, competency assessments Communication to relevant stakeholders

Execute the plan Pilot Modify, if needed Implement Maintain

Evaluate effectiveness Identify indicators of success Monitor and measure Commit to continual improvement

Expanding the journey… Provider Onboarding Experience

Identify need for change…(reasons) Onboarding and credentialing process perceived as lengthy Delay in practitioner start dates Loss of practitioner applicants Decrease in revenue Impact on access to healthcare for patients Multiple handoffs resulting in rework and miscommunication Lack of knowledge of each others’ processes

Identify Stakeholders Practitioner Employment Contract Management Center for Practitioner Information Medical Groups Medical Staff Services Operations Network Management Practice Management Managed Care Contracting Revenue Cycle/Business Office Risk Management Public Affairs and Marketing Legal Recruitment

Engage Stakeholders Two day value stream analysis Current state process flow Future state process flow Team roles and responsibilities Definitions: onboarding, contracting, recruiting, credentialing, enrollment Set high-level goals and metrics

Future state goals… Onboarding/Credentialing “on time every time” Single point of contact Effective communication Standardization of processes Maximize use of technology Stakeholder education of onboarding/credentialing process Parallel rather than sequential processes Increase revenue Timelier patient access to practitioners

Workgroups: Recruiting/Contracting Onboarding/Operations Credentialing Hospital Onboarding/System Approval Workgroup members Executive Sponsor Project Manager(s) Stakeholders

Credentialing workgroup Stakeholders: GOALS Reduce the number of times applications are returned Reduce primary source verification turnaround time Reduce number of handoffs Center for Practitioner Information Medical Staff Services Recruitment Practice Management Employment Contracting Network Management

Accomplishments Electronic signature of Medicare Physician Acknowledgement Shared mailbox for provider enrollment team Proactive collaboration for urgent credentialing projects Established criteria to deem application complete Development of training manuals Application review tools SharePoint communication site for Medical Staff Services Online peer references

and more… Streamlined process for already Advocate practitioners joining new sites Verification of Illinois, Indiana, Wisconsin and most recent state license verifications only Increased time limit for use of credentialing application from 90 days to 180 days Participation in the medical group New Leader Orientation sessions Metrics and performance dashboards

Performance Metrics Application review process Verifications start date to complete date Sent to audit to audit complete Audit complete to sent to facility Membership request received to application sent Membership request received to process complete Hire/Contract notification received date to provider enrollment process start date

Performance Dashboards

Performance Dashboards

Performance Dashboards

Other workgroup accomplishments Pre-hire and post-hire checklist Electronic employment agreement process Use of DocuSign Alignment of hospital approval meetings Addition of 2nd network management approval meeting per month Alignment and standardization of employment start dates and orientation dates Comprehensive consent and release (to facilitate information sharing) And much, much, more…

Lessons learned Inclusion of all key stakeholders is vital There is value in benchmarking The power of communication It’s ok to ask “why” as it will lead to great ideas Checkpoints for sustainability and accountability Education about the process needs to be continuous Engagement leads to acceptance of change Celebrate success!

MOST valuable lesson learned Have a little fun through the journey!