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

2. 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

4. 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)

5. 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

6. 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

7. 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)

8. 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

9. 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

10. Communication Practitioner Credentialing Status

11. 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

12. 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

13. 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

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

15. 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

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

17. 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

18. 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

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

20. Execute the plan
Pilot
Modify, if needed
Implement
Maintain

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

22. Expanding the journey…
Provider
Onboarding
Experience

23. 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

24. 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

25. 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

26. 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

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

28. 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

29. 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

30. 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

31. 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

32. Performance Dashboards

33. Performance Dashboards

34. Performance Dashboards

35. 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…

36. 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!

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