The healthcare landscape continues to evolve, with an uncertain end game due to the rates of value-based care adoption and consolidation. This uncertainty has dramatic implications for how health systems should go to market; they need a flexible operational strategy to support standing in both fee-for-service and accountable care boats. Effective network management –management of their providers – regardless of design is Job #1.
This week, Phynd clients heard a case study from one health system successfully managing through this uncertainty – UNC Health Care. Brian Ellison, Manager of UNC’s Health Alliance (clinically integrated network) and Senior Health Alliance (Next Generation ACO) presented on strategies for managing the growth of these initiatives.
The Health Alliance is one of the largest clinically integrated networks in North Carolina, with over 5,200 providers, and 3,300 providers and 32,000 lives in its ACO. The Health Alliance is unique in that both UNC employed providers and affiliated, non-badged UNC providers participate.
Brian’s team made improving provider management a priority, so care and billing processes run smoothly, as these processes depend on accurate data, shown below. As UNC’s networks have grown to thousands of providers, their system of record – a series of spreadsheets, each with thousands of rows (one for each provider), and a hundred or more columns for NPI, TIN, clinical addresses, billing address, and more – was completely unwieldly.
Brian’s team sought a capability to serve as a single database for all providers. They settled on Phynd as it met their need for a cloud-based capability that could scale with UNC’s own network growth and could take continuous inbound feeds from UNC’s credentialing system, easily make updates, and have updates automatically fed to UNC’s Epic system – already fed by Phynd, which is in use at other UNC departments.
The implementation process was straightforward. During the data preparation phase, Phynd and Brian’s team consolidated provider data from spreadsheets, Epic, and credentialing systems. Data was deduped, normalized, and loaded into UNC’s instance. The team configured data governance settings, including users’ data access, and completed in-bound and outbound system integration. Training was straightforward and UNC went live in March 2019.
Since go-live, the UNC Health Alliance and Senior Alliance have quickly benefited from:
- Elimination of multiple Excel-based payer-specific rosters. As changes are made in Phynd (e.g., location names), they are immediately captured on payer rosters
- The resolution of identifier (NPI, Tax ID) issues previously occurring at enrollment, preventing claims issues downstream. This challenge has been especially prevalent working with independent practices, where until Phynd, information was sent manually.
- A 99+% reduction in returned mail of required ‘welcome to the Next Gen ACO’ letters sent to participating providers, saving substantial administrative overhead and ensuring that UNC Health Care is in compliance with CMS monitoring requirements.
Brian is executing a roadmap for expanding Phynd’s use, including deploying Phynd’s Provider Search on the Health Alliance and Senior Alliance Find a Doctor websites to ensure patients can readily find in-network providers. Team members are exploring using Phynd’s Internal Search Directory, a branded website offering provider search for Health Alliance staff to help with care coordination. Phynd’s Provider Outreach digital campaign manager may well come in handy to improve regular communication with participating network providers, giving news updates of additional resources and also requesting the providers or their delegates review and update address, insurance and other information as needed.
We’ve made Brian’s presentation available here for participating health systems and other provider staff.