HIT Think How artificial intelligence can aid post-merger integration

More than just a buzzword, artificial intelligence is already proving to be a game changer for organizations across a variety of industries—despite being in its infancy stage.

Building off digital transformation, AI empowers organizations to leverage vast of amounts of data that is collected and generated. Using machine learning, AI enables mountains of data to be analyzed for trends and insights at rates much faster than what any human can deliver.

For example, wealth management companies utilize AI and algorithms to scan data in the markets to predict the best stock or portfolio based on preferences. Advertisers use AI to target consumers by seeking out specific audience characteristics.

In the healthcare industry, AI has the potential to significantly change patient outcomes with faster, more accurate diagnoses. AI-powered, technology-utilizing machine learning is slowly entering the market to improve analytics and research. Two examples include leveraging data to find new links between genetic codes and the ability to detect and highlight abnormalities in medical imaging systems like X-rays and MRIs.

Operational departments within the healthcare industry also benefit from AI. This is welcome news, especially for health systems and hospitals involved in post-merger integrations.

For the past several years, healthcare merger and acquisition activity has dominated headlines. Some of the more notable deals include CVS Health’s $69 billion acquisition of Aetna in November 2018 and Catholic Health Initiatives $29 billion merger with Dignity Health in 2019, which formed one of the country’s largest health systems, CommonSpirit Health.

With these deals now closed, a new challenge begins—post-merger integrations. During this stage, assets, personnel and business activities of the two companies are combined. Post-merger integration is also where the true value of AI can be realized, particularly when dealing with labor-intensive processes like contract management, credentialing and provider enrollment.

During a merger or acquisition, a newly formed entity can be left to deal with easily tens of thousands, if not millions, of contracts. Contracts likely include, but are not limited to, payer and physician contracts, plumbing, sutures, linens and more. During the post-merger integration stage each contract must be reviewed to assess status and a HIPAA business associate agreement analysis must be performed. AI-powered contract management systems greatly speed this process while providing unprecedented levels of contract visibility, compliance and risk mitigation.

Using AI with machine learning, contract terms and conditions are identified and BAA audits performed. Contracts without the required BAA are flagged for immediate follow-up to ensure one is created. Otherwise, each business associate that does not have a BAA is a risk for non-compliance is identified. This can easily add up to hundreds of thousands, even millions, of dollars in fines for a large hospital or health system.

Integration chaos is expected fallout from post-merger integrations, and it can quickly become overwhelming. This is particularly true when trying to navigate thousands of contracts. When not managed accurately, the financial implication of non-compliance can be devastating.

The typical error rate is 10 percent of total contracts, with fines averaging $31,000 per violation (per the Department of Health and Human Services).

To put this into perspective, if a hospital has 1,500 contracts and 180 contracts (roughly 12 percent) are missing BAAs, the fine potential is greater than $500,000. The larger the hospital or health system, the greater the risk.

AI-powered contract management systems provide an easy solution to the traditionally complex, and often costly, integration phase. With the right solution, streamlining the contract management process, and mitigating risks and fines, can be achieved.

Becker’s cites Newport Credentialing Solutions

Becker’s Hospital Review has named Newport Credentialing Solutions to its list of “Healthcare Revenue Cycle Companies to Know in 2019.” The companies were cited for their ability to assist hospitals, health systems, physician practices, and healthcare organizations with increasingly complex revenue cycles, and helping them work with government and private payers and patients to collect.

Read the article here.

Cooper University Credentialing Case Study

After partnering with TractManager’s credentialing, verification, and enrollment solution, Cooper University Health Care receives 400% ROI by implementing cloud-based analytics and IT-enabled credentialing services.

Download this case study here.

How credentialing systems can create a competitive edge for payers

In the highly-competitive insurance industry, payers are constantly tasked with finding new ways to differentiate themselves from their competition. An often-overlooked opportunity to stand out among the crowd is the provider data management and the credentialing process.

Credentialing starts during the physician on-boarding process. Recruitment of providers onto payer panels is critical to a payer’s success and presents a unique first-impression opportunity for payers. This is where a payer sets the stage for the physician relationship going forward. A smooth, automated on-boarding process is key to achieving physician satisfaction and creates a positive start to the relationship. Identifying additional ways to add value throughout the credentialing lifecycle is essential to maintaining a mutually beneficial relationship.

For example, collecting information and providing it to a physician, who in turn can pass it along to their patients, improves patient satisfaction, and therefore physician satisfaction. Something as basic as the layout of a building can add significant value to both physicians and patients. Knowledge of which doorway patients must go through or whether a clinic is on the first or second floor is important to patients with limited mobility as it represents ease of access. Payers that are able to track this level of detail, which is then passed onto the patient, differentiate themselves from those payers that can’t track this information. The result is happier physicians and patients.

Unfortunately, because most payers use hospital credentialing systems, which are built specifically to meet hospital credentialing needs, the data tracking and automation capabilities payers need to be successful and compliant aren’t typically available. Those that have turned to home-grown payer-specific credentialing systems are dealing with their own set of problems as these systems are not adaptable nor do they offer true enterprise-wide capabilities.

While it’s been a long time coming, payer-specific enterprise provider data management and credentialing platforms are slowly entering the market. These systems present a unique opportunity for payers to separate themselves from the competition by extending the value they offer.

Meeting Payer-Specific Needs

Vendors have taken what they’ve learned from hospital credentialing systems and incorporated best practices to create highly-customizable credentialing platforms that meet the specific needs of the payer market. These systems are customizable and nimble; enterprise-based and in the cloud, so they can be used by multiple groups in multiple states across the country. Furthermore, improvements in business intelligence, analytics, and advanced reporting ensures that payers can easily report on their data and use that data in actionable ways to improve physician and patient satisfaction. Customized payer platforms also improve efficiency and reduce costs for payers.

It is time payers raise their standards and stop settling for second best. There are many exciting technological advances happening in the payer space. A hospital credentialing system that can’t be customized to a payer’s specific data needs is no longer enough to be successful in today’s competitive payer landscape. Advantages exist for payers that recognize the value in payer-specific platforms. And as technology continues to evolve, the ability to integrate payer credentialing software with contract life cycle management – which has already been done on the hospital side – will further streamline processes.

CIOReview: 50 Most Promising Healthcare Solution Providers – 2019

The healthcare industry has for long been skeptical about incorporating up and coming technologies primarily due to the safety and compliance issues. However, the scenario is changing with the advancements in the technologies that provide far greater advantages in comparison to limitations. By leveraging technologies such as telehealth, IoT, cloud computing, AI, AR, VR, and others, the healthcare providers can offer more effective, efficient, and quick care to their patients at more affordable costs.

In a large country like the U.S., where the people’s access to healthcare is limited, telehealth/telemedicine has proven to be an effective way in extending the reach of healthcare. This is also in tune with the healthcare industry’s growing trend of a patient-centric approach since the patients can reduce the number of visits they have to make to their physicians. The combination of telemedicine and telehealth technologies has resulted in the emergence of the Internet of Medical Things (IoMT). This group of connected devices plays a critical role in the tracking and prevention of many chronic diseases. Additionally, the combination of AR and VR has helped in the treatment of various conditions such as dementia, cognitive impairments, and more.

The number of providers in the markets who develop healthcare solutions has increased significantly. To help healthcare providers in their journey to provide effective and efficient care for their patients, a distinguished selection panel comprising CEOs, CIOs, VCs, and CIOReview’s editorial board has selected a list of the top healthcare solution providers. These companies leverage emerging technologies to come up with practical solutions in healthcare.

Learn more about Newport Credentialing Solutions.

Industry Voices—Hospital credentialing systems are no longer enough for payers

Built on of the theory that some things just don’t fit, the square-peg-in-a-round-hole analogy can easily be used to describe the process in which insurance payers manage provider credentialing.

Most insurance payers rely on hospital credentialing platforms to do payer-specific credentialing. And while there is a lot of overlap between hospital and payer credentialing activities, particularly with regard to primary source verification, hospital credentialing systems are the square peg.

The payer problem

Some payer-specific credentialing systems are available, but they are typically home-grown and therefore not adaptable, or they lack true enterprisewide capabilities. As a result, most insurance companies use hospital credentialing systems that come with their own set of problems. Because hospital credentialing systems are built for the specific needs of a hospital, they lack the data tracking and automation capabilities payers need to be successful and compliant.

In the highly competitive insurance industry, payers are constantly tasked with finding new ways to differentiate themselves from their competition. Enhancing the physician on-boarding process through electronic automated processes as well as providing physician-specific data are two ways that payers can improve physician satisfaction and ease that process.

Consider, for example, the layout of a building.

Knowledge of which doorway patients must go through or whether a clinic is on the first or second floor may seem like insignificant details to some, but for a patient with mobility issues, a doorway or floor can represent ease of access. Collecting this information and providing it to the physician, who in turn can provide it to their patients, improves patient satisfaction—and therefore physician satisfaction. Payers that are able to track this level of detail for patients are much more appealing for a provider to work with.

And while this information is important to payers, physicians, and patients, it is often less relevant to the hospital for compliance purposes and therefore, is not tracked in hospital credentialing systems.

Another example of ill-fitting hospital credentialing systems is the inability to perform roster maintenance. Payers sell different types of insurance. They need a place to store customized rosters for their specific products and a process for managing this information. Because this information is irrelevant to the hospital, hospital credentialing systems don’t offer data fields or an easy method to track, store and easily report this data. As a result, payers must use yet another system to manage their roster maintenance.

Despite limitations, hospital credentialing systems are force-fit by payers. To offset the shortcomings of these systems, payers use multiple systems to address their unique credentialing needs. This siloed approach, however, is inefficient. Because data is housed in disparate systems, it is less accessible, which diminishes its value.

 A brighter future for payers

Insurance payers no longer need to play second fiddle to hospitals when it comes to their credentialing technology platform needs. While it’s been a long time coming, payer-specific enterprise credentialing platforms are slowly entering the market. Vendors have taken what they’ve learned from hospital credentialing systems and incorporated best practices to create highly customizable credentialing platforms that meet the specific needs of the payer market.

These systems are flexible and nimble; enterprise-based and in the cloud, so they can be used by multiple groups in multiple states across the country. Further, improvements in business intelligence, analytics and advanced reporting ensures that payers can easily report on their data as well as use that data in actionable ways to improve physician and patient satisfaction. Customized payer platforms also improve efficiency and reduces costs for payers.

While this is considerable progress, additional development must take place on the payer side. Integrating payer credentialing software with contract life cycle management will further streamline processes.

This integrated platform is available to hospitals today and the benefits are significant. Using an integrated credentialing and contract life cycle management system, hospitals can save significant time by eliminating duplicate data entry.

Integrated platforms also offer hospitals cross-team access to provider data, which allows everyone involved in getting a payer ready to bill to track where a contract is each step of the way while greatly speeding processes. Similar benefits can be experienced by payers when payer credentialing systems are integrated with contract lifecycle data.

It’s time for payers to seek the right fit. Settling for a hospital credentialing system that can’t be customized to a payer’s specific data needs is no longer enough to be successful in today’s competitive insurance landscape.

We use cookies and other tracking technologies to improve your browsing experience on our website, to show you personalized content and targeted ads, to analyze our website traffic, and to understand where our visitors are coming from. By browsing our website, you consent to our use of cookies and other tracking technologies.
Thanks for signing up. You must confirm your email address before we can send you. Please check your email and follow the instructions.
×
×