Automated Provider Contract Management - Case Study: CareSource Management Group

 

Executive Summary

 

Like most health plans, CareSource Management Group has suffered from inefficient manual provider contracting processes. Its paper-based systems created poor quality control, increased risk exposure, and had a negative impact on their fast growing business. As Ohio’s largest Medicaid-managed care plan, CareSource needed to streamline the way it served its 590,000 members and providers across the state. To meet these challenges, CareSource sought an efficient and effective solution, preferring an off-the-shelf solution to reduce the costs associated with customization.

CareSource selected the Portico Choreo Suite to streamline its provider network management. Within three months, CareSource reaped the benefits of a fast implementation across its enterprise and realized a return on its investment that included a 50 percent reduction in contract development time.

Manual Contracting Creates Unnecessary Challanges

 

Many healthcare payers still suffer from the limitations of paper-based systems in the management of their provider contracts. In the United States alone, more than 1,000 healthcare payers create and maintain contracts with anywhere from 500 to 100,000 providers. These paper contracts create huge volumes of paper, extend provider enrollment timelines, and generate unnecessary business risks for organizations like CareSource, where contracts with providers, hospitals, and ancillary service providers are created and amended each year.

For example, guiding providers through the manual contracting process of joining the CareSource network was painfully slow. The contracting department estimated that each provider contract went through a minimum of 12 manual hand-offs during its development, negatively affecting provider relations. These processes, plus manual notifications and approvals, led to nearly 40 to 50 percent error rates, causing legal, financial, and operational risks. Additionally, paper storage of contracts caused problems among internal departments, as key contract information was not accessible in a timely manner. To improve provider relations, operations, and mitigate risk, CareSource needed a streamlined contracting process that improved provider contracting timelines, minimized or eliminated paper, and provided appropriate quality controls.

Health Plan Specific Solution Critical to Success

 

To meet its contracting needs, CareSource’s IT department identified basic solution parameters and research options. An ideal contracting solution would automate both internal and external aspects of contract development, provide high ease of use, and create internal checks and balances with quality and risk management controls. Initially, it seemed reasonable to find an off-the-shelf solution to meet their needs. However, the more CareSource looked at their requirements and available solutions; it became apparent that a generic contracting product would not suffice. Customization of this type of solution would take months, and the cost of customization would be prohibitive.

Instead, CareSource needed a solution mapped to its existing health plan contracting workflow - one that would interface to their provider record of reference/claims payment system, all while meeting HIPAA and other health care security compliance needs. Plus, CareSource sought a partnership with a vendor who would help with implementation, provide ongoing support, and offer superior training to ensure successful internal adoption of the contracting solution.

The ultimate solution that met these needs was Portico’s Choreo Suite, designed specifically for health plan provider contracting.

“The solution was so far superior in meeting CareSource’s provider contracting needs that we decided to forego the RFP process,” stated Mike Knellinger, CareSource CIO. “This product represented the niche we were looking for and provided the best value for customization compared with competitor’s products.”

True Provider Contract Management:

 

Portico Choreo Suite

 

CareSource chose to implement key products from the Portico Choreo Suite to improve their provider contracting processes and meet the needs of the entire organization.

CareSource selected:

* Portico Choreo™ Contract Manager is designed specifically for health plans to streamline and simplify provider contract management. Organizations can review and approve contracts, track alternative language choices, create and view standard reports, and administer a variety of other common provider contracting tasks and workflows.

* Portico Choreo™ Courier enables organizations to send contracts, rate notifications, legal communications, and other documents to their providers with mass electronic mailings. Contracts can be executed electronically using proprietary eSignature technology and a secure Web connection.

* Portico Choreo™ Negotiator enables secure online negotiations of contracts in Choreo® Contract Manager. This allows health plans to negotiate and memorialize contract terms and rates online, while maintaining the integrity of the original contract in Choreo Contract Manager and tracking all negotiation activities.

Together, these products allow CareSource to improve the information transparency and workflow process automation necessary to competitively grow and manage provider networks.

With the Choreo Suite, Care Source staff can now:

* Manage provider contracting workflow using simple contract creation wizards.

* Track full audit trails of contract activity without hiring external consultants.

* Enforce compliance in both workflow and language across all contracts.

* Control information access with assigned roles and user permissions.

* Manage contracts with version control and electronic distribution and signatures.

Process Redesign Improves Implementation and ROI

 

Once the appropriate Choreo products were selected, CareSource worked with Portico to identify key areas of process improvement. One such area was the reduction in the number of days needed to process a new physician when entering the CareSource network.

To achieve these process improvements, CareSource completely redesigned their contracting process and worked with the Choreo project team to map their new processes to the Choreo system. Concurrently, the pre-implementation process gave CareSource the opportunity to analyze their entire workflow and identify process improvements that would lead to a smooth flow with less paper.

This work proved invaluable throughout implementation and in assessing the ROI of the Portico Choreo Suite.

Collaboration: Key to Fast Track Implementation

 

By Collaborating with CareSource, the Portico Choreo solution was able to be effectively implemented, across the enterprise, in approximately three months, outpacing both organizations’ initial expectations.

In addition to creating a true collaborative relationship, the implementation was also accelerated by working with a niche product targeted to CareSource’s healthcare business throughout the process. With standardized reports, templates, and alternate language options that met their specific needs, CareSource quickly realized those features alone would greatly reduce the number of errors in the contract development process.

“The implementation process also provided us an opportunity to address the scope of users’ access to information,” noted Salli Duncan, VP Network Operations at CareSource. Defining user permissions – so specific users could only view directly relevant information – meant contracts could be processed more quickly without the delays or distractions caused by unnecessary information access.”

When completed, the speed of the implementation allowed CareSource to start measuring its ROI almost immediately.

Automation Brought Instant ROI

 

With the fast three-month, enterprise-wide implementation of the Choreo Suite, CareSource quickly realized the savings from automating and improving its systems.

By standardizing its contracts through Choreo, CareSource reduced the number of manual hand-offs by more than 50 percent. This standardization, along with instant access to critical contract information, meant contract managers could spend their time working efficiently and effectively with providers instead of fighting manual processes.

In addition, the version control and online red-lining features in Choreo greatly reduced contract errors.
CareSource was able to reduce the provider enrollment from two weeks to one. These changes instantly led to significantly increased provider satisfaction.

Built-in contract routing also reduced CareSource’s signatory process from an average of two weeks to two days. This meant that for every 500 contracts created, CareSource now saves more than $10,000.

Interfacing CareSource’s other systems with Choreo will prove another way for CareSource to save time and reduce errors. By interfacing with its provider system of record, provider demographics can be linked to Choreo. They also plan to expedite their claims payment process by linking pricing and rates between Choreo and its claims processing system.

CareSource Process Improvements and Savings Analysis

 

 

About CareSource Management Group

 

CareSource Management Group offers a full spectrum of services for the administration of public-sector health care programs. Among these services are general administration, including claims processing, case and medical management, provider relations, decision support informatics, quality improvement, and regulatory compliance; member services, including a member call center and 24-hour nurse advice line; and financial consultation and turn around. CareSource Management Group also provides services to non-profit managed care plans that serve more than 553,000 Medicaid consumers in Ohio.

For more information about CareSource Management Group, visit www.csmg-online.com.