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Case Studies

Hospital Network Pilots Acorn and Improves Credentialing Efficiency 83%

Project Background

One of the largest acute care and behavioral health hospital networks in the United States has more than 300 locations. This organization was experiencing costly delays in credentialing and dissatisfaction from physicians working at their hospitals because it was using an outdated credentialing platform to meet new demands on its Medical Staffing Services group. The hospital network’s corporate and hospital leadership decided to take a measured approach and enlisted Acorn to compete for the business.

The pilot project was designed to evaluate Acorn against the incumbent credentialing platform at a hospital located in Southeastern Florida, where they have more than 1,000 practitioners in a 233-bed facility. The objective was to evaluate the impact of moving their Medical Staffing Services to an advanced automated solution that decreases the amount of time needed to get practitioners credentialed. The context for the project was to meet the needs of a major health system with hundreds of payer groups and evolving the processes for credentialing, privileging and enrollment as the hospital network moves to a delegated network designation that will require new reporting and strict audit capabilities to meet the new sanctions.

Typical Credentialing Process

The credentialing process involves the provider, the Medical Staff Professional, and the leadership of an organization. The process starts with the provider applying for Medical Staff membership and clinical privileges. The Medical Staff Professionals then go through the arduous process of primary source verification of the provider’s education, affiliations, licenses, boards, references and other sources to compile a database of the provider’s training and experience, character and competence. This primary source verification must follow state and national regulatory guidelines and the hospital’s established bylaws, policies, and procedures.

The industry’s average processing time for this process is 90 days, with 60 days as a gold standard. Following the compilation of this data, the Medical Staff leadership and Committees must review the data and make recommendations for the provider’s suitability to join the Medical Staff and determine if the provider is competent to perform the privileges requested. This process can take up to 30 days. The importance of this process cannot be understated. Negligent credentialing can result in significant risk to an organization and can result in millions in lost revenue, increased liability, and expensive court cases.

It is important to increase the efficiency of the process without impacting the quality of the work. The credentialing software partner chosen to help manage the workflow and task automation can make or break the entire process.

Client Problem

The hospital network was using credentialing software that did not meet their workflow, business needs, or staffing demands. While it improved the efficiency of some processes, many were still paper-based, time consuming, and repetitive. There was dissatisfaction from providers that the process took too long and required frustratingly repetitive data entry to complete the application. The primary source verifications process usually required two or three attempts to get responses, making the process laborious and tedious while costing valuable time. It resulted in delays in care and severe losses in revenue.

There was dissatisfaction from providers that the process took too long and required frustratingly repetitive data entry to complete the application. It resulted in delays in care and severe losses in revenue.

Author

The review process by Medical Staff leadership required office visits to review files, which took time away from their offices or personal life. The Committee process required onsite meetings to review and make recommendations. Practitioners would miss cut-off dates for committee or peer review/quality audits and special meetings would need to be called to finish the process.

With the existing system, credentialing and practitioner review processes took valuable time away from medical staff and administration at the executive levels. This led to even more delays in patient care, as well as revenue losses for the organization. But it also impacted practitioner retention, resulting in millions of non-recoverable dollars for the organization.

Acorn Solution

Our client instituted Acorn’s credentialing software at its test-site hospital and instantly improved the productivity of the Medical Staff Office because our automated solution significantly decreases the turn-around time of primary source verification. The use of an online application process increased the satisfaction of the Medical Staff, which led to a high adoption rate of the new automated processes.

Acorn’s automation transformed a number of paper-based processes into simplified digital data capture processes, which increased efficiency by 69% in the first few months. It is expected that once the Acorn solution is fully integrated into the hospital’s system, the overall efficiency rate will be 83% or better.

Acorn’s automation transformed a number of paper-based processes into simplified digital data capture processes, which increased efficiency by 69% in the first few months. It is expected that once the Acorn solution is fully integrated into the hospital’s system, the overall efficiency rate will be 83% or better.

Benefits: Provider Satisfaction

Our client reports that provider satisfaction increased significantly with the Acorn credentialing solution. Acorn offers each provider an accessible portal that we call a Medical Passport, which is a central repository for data and career-related documents that gives each practitioner control of their own information in the system. The ability to use a mobile phone to scan and upload documents, complete and submit their applications online with an intuitive tool made it easier and faster than a paper process. Added benefits included the ability to have their group managers manage the process for them, and the ability to populate their data from a CAQH import further streamlined the data entry process. In addition, once their data was entered, it was easy to maintain, and they received automatic email alerts to expiring credentials.

Benefits: C-Suite Oversight

Communication of the progress of provider applications and key critical information is easily communicated to C-Suite hospital administrators with Acorn’s graphic dashboard and Big Data analysis tools. The ability to schedule reports to be auto-emailed to the C-suite streamlined the communication process for our client.

Benefits: Increased Revenue

The highly automated Acorn solution implemented at our client’s hospital location has integrated fragmented processes, streamlined the credentialing process, and increased satisfaction of the credentialing staff, providers, and executives. This has resulted in time and money savings through efficiency but also through an accelerated onboarding process for providers that enables them to generate revenue without delay. The expansion of this initiative across the client’s entire hospital network will increase the organization’s revenue exponentially and well exceed the investment in moving to a highly automated Medical Staffing process.

What’s Next

The client is now moving to their behavioral health hospitals that are still using manual processes to credential their practitioners. This initiative has an even larger goal to produce an 89% increase in productivity driving increases in revenue due to timely credentialing. The enrollment gains are projected to be upwards of 20% to 30%. We are also estimating by reducing 10% in the time it takes to enroll their physicians it will increase revenue approximately 2% to 4% across the organization.

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