The Business Re-Engineering Group (BRG) and The Emory Clinic have successfully completed a pilot of a radically redesigned process to "arrange care" for patients. The redesign affected every element of the process to schedule appointments, register
patients, certify insurance and order services - all the activities that typically occur before a patient sees the physician.
One Job Replaces Five
A critical concept to be tested was a new job definition - the arrange care representative, who works in a team with other reps. This person would be doing the work previously done by five different people in three different organizations.
"We wanted to eliminate hand-offs that were adding time and cost to the process, causing rework, and adversely affecting patient service," says Allan Gibson, project manager. "If one person could do the whole job, we would gain significant improvement in process performance."
To set up the concept, the telephone receptionist/scheduler job position in the medical section was redefined, to include patient registration and insurance verification responsibilities. The patient now had access to a "case worker", one person empowered to make all the necessary arrangements for care.
Knowledge Base Is Critical
A key factor in the success of the new process would be the ability to provide the arrange care rep access to the knowledge of the governing rules for each step in the process.
"There is a huge knowledge base required for each step," explains Gibson. "That knowledge was in the heads of the people, on post-it notes stuck on computer terminals, and on various memos and notes. And these rules kept changing every day as new physicians arrived and new managed care contracts went into effect."
To solve this problem, knowledge data bases and rules-based processing support were developed in the "team assistant", a PC-based expert system for each rep. The system identified appointment type based on patient problems/symptoms, identified the physician specialists most suited for the patient, matched patient demographics against physician criteria, and identified the first available physicians for the patient.
The Process Is Continuous
Once the appointment was made, the rep proceeded with the patient registration or update, a task previously done in another department.
"Then the insurance knowledge base kicked in," says Gibson. "Based on the patient's insurance plan, the team assistant would apply that plan's rules regarding the need for pre-certification or authorization, and automatically perform the required tasks. It would generate a fax to the carrier or check a membership database, and essentially ensure the Clinic that the terms of reimbursement were complied with - before treatment."
All these activities were recorded in a tickler file for each patient's appointment - so that they could be followed up in a timely basis, and reviewed when the patient showed up. As the patient checked in at the medical section, bypassing a central registration area, the rep made sure that all open items were completed.
The Job Is Continuous
"The tickler really increased productivity," says Gibson. "In the previous business model, if you had no stimulus (e.g., the phone was not ringing for a scheduler), then you had no work. Under this approach, if you have no activity, then you bring up the open ticklers to finish them." The system keeps track of the tasks each rep completed so that productivity could be factored into personnel reviews.
The whole recognition and reward system would have to change for the new job. The emphasis moved - from completing a transaction - to providing quality service to patients and physicians, providing quality information to downstream business processes, and achieving high levels of productivity, as an individual and as a member of the Arrange Care Team.
The Results Were Dramatic
So what were the tangible results? In the pilot period, the arrange care team achieved:
• 15% work elimination
• 40% productivity increase
• 90% cycle time reduction
Additionally, new physician productivity improved significantly; physician/patient mismatches were eliminated; and reimbursement misunderstandings were clarified up front.
"We achieved even more than we thought we would, and we proved it will work," says Gibson. "The potential benefits of a clinic-wide implementation are huge."
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