Improving Productivity and Operational Efficiency with Data Transformation

A large Puget Sound Behavioral Health Care Provider asked us to automate a time-consuming, manual patient documentation process that was resulting in coverage denials for their clients.

The Challenge

The revenue cycle team was unable to keep pace with 20 daily denial/error lists often requiring a dedicated FTE to work through text-based county error reports using a sequential approach that often resulted in redundant communication with county officials.

What Was At Stake

Over 90% of this organization’s customer base live at or near poverty level. The organization contracts extensively with federal, state and local agencies using capitated payment models and the growing instances of errors in patient documentation were leading to patients being at risk for coverage denials.

The Solution

OTB Solutions used a combination of process and technology to streamline the error capture and handling process using tools such as Monarch and Power BI to quickly transform the data to a more usable format thereby freeing up the workforce to fix systemic issues and analyze causes of high incidence errors. Our process and solution included:

Organizational overview and assess problem areas
Develop cost of “status quo”
Build Process maturity
Re-design Technology footprint
Share Rationale for approach used
Measure Productivity improvement
Looking ahead – future proofing
Adoption and Change Management Job Aids

Results

The new process permitted the creation of worklists/queues allowing multiple resources to work on the denial reports increasing productivity many fold lowering error encounters from thousands to less than one hundred. Using visualization capabilities of Power BI, users were able to use self service capabilities to analyze and drill through high incidence errors, simulate temporal trends and cross reference several distinct error types in many cases to a causal reason.