The Challenge
BJC Healthcare consists of 9 community hospitals, 3 academic medical centers and multiple community health locations. The system had come together for competitive market reasons, leaving many disparate revenue cycle processes in place. As part of its revenue cycle transformation, management wanted to implement a standardized financial clearance process for outpatient services that would improve the patient experience as well as produce improved financial results.
The Story
Each of the community hospitals had a partial financial clearance in place. None had a complete process. BJC leadership recognized that standardizing processes in a centralized financial clearance unit would achieve the greatest improvement at the least cost. The scope of the project included pre-registration, insurance validation, obtaining and/or validating authorizations in order to financially clear our patients. The scope was expanded two years later to include point of service collections. Given the complexity of the implementation, BJC engaged Salvum Consulting and its subcontractor, Goldman Health Strategies, LLC to assist with the implementation.
The Solution
Partnership
The consulting project team partnered with BJC patient access leadership to successfully implement a centralized financial clearance unit. The unit began with surgery and radiology in a pilot mode until the community hospitals were all part of the new central team.
Project Management
The consulting team fleshed out and monitored the detailed project plan including key dependencies between tasks.
Business Model, Workflows and Staffing
As part of the implementation, the team developed detailed workflows, operating processes, policies and procedures, and determined performance metrics and monitoring tools. We developed a staffing model to determine initial scope staffing and help identify staff to transition from the community hospital to the centralized unit.
One of the biggest challenges facing the team was knowing whether or not a service required an authorization. Working with the managed care department, we created a tool that allowed the team to determine authorization requirements on a payer specific basis.
Change Management
To manage a change of this magnitude, BJC Patient Access leadership and Goldman HS met with community hospital leadership to obtain their buy-in, identify staff to transition to the new unit and communicate the changes to the medical staffs.
Training and Go-Live Support
Finally, the team provided on site support and served as interim management during the first month of implementation. This day to day support allowed us to quickly identify and resolve issues, from IT requirements through fine tuning of workflows.
The Results
Within a year of implementing a standard pre-service financial clearance process for the four pilot community hospitals, the unit has expanded to include all hospitals in the system, improving the patient experience and increasing point of service payments.