Case Study: Healthcare
From-scratch provider data stewardship earns wins in quality, compliance, and cost-containment
Health plan experiences immediate improvements in PDM and credentialing/recredentialing with HGS
62%Turnaround time improvement in recredentialing
54%Turnaround time improvement in credentialing
30%Cost reduction through labor arbitrage and process reengineeringThe solution
A blueprint for PDM
HGS began with an in-depth analysis of the client’s provider data quality program. The client had limited quality reporting, tracking and workflows in place.
Leveraging deep domain PDM experience—across people, process and technology—HGS built a blueprint for PDM, credentialing and recredentialing success. The plan started with workflows and reporting—then automation, with an eye towards automating credentialing, recredentialing, and provider verification. This end-to-end process rebuild was essential to fully optimize the client’s PDM and operational management.
Offshore support
A 12-person HGS team launched support in Hyderabad, India. HGS, as the first outsource service provider for this client, ensured the client benefitted from both our domain expertise and labor arbitrage opportunities.
Purpose-built PDM tool: Provider Forward
To address the client’s key objective, HGS leveraged our purpose-built PDM tool: Provider Forward.
Provider Forward is a workflow management tool that enabled the client to track and monitor inventory in real time, and to pull quality and production reports.
The tool helped to optimize leader productivity—clearing backlogs for more productive, efficient adherence to process. Today, the client has an improved ability to track historical data, for further support of penalty avoidance and audit success.
Results
From intake and assignments to tracking and monitoring, the client has experienced immediate improvements across PDM and credentialing/recredentialing. Automated workflows, outreaches and follow-ups are supported by standardized templates for auto email acknowledgements to providers. Additionally, HGS manages audit samples (sampling method and size), audit templates and overall audit process along with quality score reporting along with trending, along with effective monitoring of aging and TAT of inventory. The client agreed to augment this service with provider data validation.
62%TAT improvement for Recred
and 54% TAT improvement for Cred
89%quality improvement
for Recred and Cred
83%TAT improvement for PDM
95%quality improvement for PDM
30%cost savings as a result of offshoring,
end-to-end process reengineering, and automation of PDM inventory management and dashboards
25%increase in team size
and future account growth
