HEOPS-7 Proven Strategies for Saving on Network development ProjectsSTOP THE LEAK: 7 Proven Ways to Save Big $$$ On Provider Network Development

Copyright 8.12.2014: Scientific Cowboys – Nancy C Everitt, PMP

The next 5 minutes could save you $10K or more in savings. This article compiles Lessons Learned from over 500 HEOPS network development projects across a variety of payors and network types.

The results of the compilation are  seven proven methods for enhancing the success of expedited network development (provider networks built in less than 90-120 days) while removing unnecessary cost from the process. Interested? Read on…

1. DEFINE SUCCESS: Savings Potential $1 to infinity

It is not uncommon to see network development projects with vague goals similar to the ones below:

  • Commercially viable network
  • As many providers as we can get
  • 100% of the competitor network.

All of the above scenarios are unattainable with out further specificity. One of the most valuable assets is a working relationship between medical management and development so that “true” network design and build occur in tandem. Networks should be built to support the clinical goals and member access requirements for the health plan.

When you are faced with a vague goal listed above…Stop, push back. Establish a specific conservative goal and then refine as more information becomes available.

 

2. REFINE SELLING PROPOSITION: Savings $ 1 to infinity

Providers are interested in BENEFITS, what contracting with XYZ health plan will do for them, their patients and community. Read this three times.

Often a health plan provider recruitment letter discusses  the plan, plan history, awards  etc. and has 2 sentences about BENEFITS to the provider.  Houston, this is a problem.

A standard health plan recruitment letter has a low contract return rate of 1-3% while a refined BENEFIT driven health plan recruitment letter can drive returns from 5-15%. Note: Each percentage is activity that occurs without a follow up action. Highly valuable.

Read your materials, if you are not excited at the prospect of the relationship and benefits of joining. Stop and rewrite. Providers are the life of a network. They must see and feel the vision and benefits of the relationship.

Below is a helpful checklist.

Sell benefits that matter to the provider

Understand what is important to the provider – ASK

Communications that compel!

  • Headers
  • Active language
  • Simplicity
  • Call to action

Authenticity of the message

 

3. SIMPLIFY CONTRACT ADMINISTRATION – edocs: Savings 10-25%

The use of edocuments and or edocument return can reduce contracting costs by 10-25%.

Lessons Learned:

1) providers are not 100% electronic yet, so use a combination of e documents and paper documents to minimize polarizing a process

2) fax and efax – crazy old technology but effective, we see this as the most consistent document return method fast, inexpensive and familiar

3) electronic signature – amazing process, can’t be beat however do not use as your sole method of contracting.

Work with legal. Electronic  vs.  wet signature is often a big internal issue in many organizations, press the issue. There is a legal definition of electronic signature and should be utilized. Hard copies and wet signatures are very expensive and administratively burdensome.  Often when push comes to shove, hard copies and wet signatures are legal “preference” rather than legal “requirement”.

 

4. SIMPLIFY CONTRACT ADMINISTRATION – Document Refinement and Redesign: Savings 10-25%

How many attorneys are workflow specialists? How many contracts contain 4 or more areas that require signature or data to be deemed complete? Each page and data element in the contract increases the likelihood of an incomplete or incorrect document return requiring rework. While this can be eliminated with e-signature documents the frustration factor lingers. Below are three Lessons Learned that may sound strange but work very well to minimize rework and cost.

Lessons Learned:

1) Condense signature and data entry to 1 – 2 pages max in a contract

2) Flip the process, place the signature page at the beginning of the document

3) Lead the contract  with an integrated W-9.

 

5. MAIL ROOM and DOCUMENT RECEIPT: Cost Increase 10-20%

It is not uncommon that a recruitment project begins,  the process appears to be working then a bottleneck occurs in the mailroom or in the document receipt area. The inability to receive, document, parse and process inbound contractual documents the day of receipt increases costs 10-20% through rework (lost and delayed documents) and duplicative work (seeking contracts and documents that have already arrived but are not showing as received).

In an expedited build, ensure that your workflow is solid at ALL stages.

  • If not, outsource this step to reduce cost and save time.

At HEOPS, we have learned that if a client processes documents we need to add 10-20% risk buffer on the project since the inbound receipts will likely be delayed or compromised.

 

6. SYSTEMATIC APPROACH: Cost Savings 20-50%

  • There must be a plan.
  • The plan must have goals.
  • The goals must have milestones.
  • The milestones must have predecessor activities.
  • The predecessor activities must have a work breakdown structure.
  • The work breakdown structure must have work packages.
  • These work packages are assignments for the team. Now begin.

All too often Network Development Projects start and stop at the goals and raw data,  then it’s a free for all for implementation. In a surgical suite the Surgeon is the leader, there is no free for all, it is a finely crafted process. The same applies to network development. Assign a competent Project Manager and/or SME to call the plays. Then systematically hold the team accountable. Very loose structures and project teams often have no hope of timely success.

Lessons Learned:

  • Have a finely tuned plan with due dates.
  • Validate the processes and tools to be used.
  • Select and replace resources quickly. Do not wait. There are talkers and doers, choose the doers.

 

7. DATA MANAGEMENT: Cost Savings $10K-$40K

On one engagement, we were asked to gap fill for Medicaid adequacy. In two days, we analyzed the provider data and identified 50% of the deficiency resolution by refining the specialty categorization in the credentialing system to include secondary and tertiary sub-specialties. Then, we identified the key providers that were getting ready to be terminated through Credentialing for failure to complete recredentialing.

In the above example, recruitment was not the first step, because the issues were deeper in the organization.

However in a standard recruitment,  DATA is key. The investment in the right SME or resource will save $10K-$40K through analytics data capture, identification of trends for the recruitment team and reduction in work duplication.

Data is king! Ensure that you invest in the right resources.

 

SUMMARY:

There are cost savings in every phase of a network development project. Keep a keen eye out for inefficiencies, question the status quo.

Above all ensure that you have a definition of success and know when to end the project based upon success or failure of the success definition. One thing that we did not list above and is difficult to quantify is …perseverance.

Short projects are hard, intense and can be uncomfortable because of the required sacrifice. Take the temperature of your team, if they lack in perseverance and a degree of self sacrificing behavior you will struggle, regardless of your plan. Match the right resources to your plan. People are built different, seek the ones that fit and enjoy the challenge.

Good luck, by implementing just one of the 7 suggestions you can save significant time and money on your current or upcoming project.

 

About the Author:

Nancy C. Everitt, MBA is the President and CEO of HEOPS, Inc. and Editor in Chief of Scientific Cowboys. Ms. Everitt is lead strategist to Clients’ on the design and fulfillment of patient access solutions such as network development and provider engagement, quality analytics, Medicare Advantage STARS strategy, disruption analysis and mapping. Ms. Everitt has been involved in the strategy of each engagement and provides significant perspective on industry best practice.

In addition to serving as Editor in Chief on Scientific Cowboys, Ms. Everitt is a frequent contributing writer to the publication sharing real world advice and operational insights on process and performance improvement. Questions on this article may be addressed directly to neveritt@heops.com.

 

 

 

 

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