Part one of a series about optimizing Epic to increase cash and cultivate loyalty in the Patient Access work of every hospital
A few years ago, in a sea of endless smartphone apps created for just about anything you could think of, a seemingly insignificant smartphone app became significant. The significance is noteworthy because in this particular segment of apps, GPS mapping, Google dominated with Google Maps. Even Google’s biggest competitor, Apple, had millions of smartphone users tethered to their iPhones in large part through Google Maps.
But even though Google Maps achieved world domination, it was still missing something. And that brings us back to the insignificant app that became significant…Waze. Waze did an incredible thing to make their app unique; to make it arguably better than even the mighty Google Maps. They harnessed real-time intelligence about traffic to make their app smarter and more useful than even Google Maps.
Waze didn’t try to compete on what was accepted “best practice” mapping technology. They instead viewed their technology in part as a community. And they activated the voice of that community to get from point A to point B faster, without a speeding ticket. Waze became significant enough that Google acquired them and assimilated the Waze community-centric traffic intelligence into Google Maps. And as we all know, Google Maps continues its world domination to this day.
So, what’s the connection to Epic and why should you care?
Much like Google Maps, Epic dominates the healthcare EMR space. If you’ve read this far, you likely have a vested interest in your own Epic EMR…an investment that includes use of the application in your hospital Patient Access work (the tip of the spear for hospital revenue cycle where benefits are determined, cash is collected, denials are born or prevented, and the face-to-face part of the patient experience begins).
And much like Google Maps, Epic for Patient Access is a solid play. Epic delivers an impressive Patient Access feature set for Registrars and Healthcare Finance Leaders at the department level and in the C-suite. Yes, Epic delivers Patient Access workflows and interoperability to make useful connections to third-party payers and supplemental technologies.
But, also like Google, Epic needs its own Waze. To achieve critical results, like more pre-service cash collection, complex benefit determination, denial prevention, and a patient experience worthy of cultivating loyalty, Epic requires effective intelligence and supplemental technology assimilated within.
There are multiple disciplines within Patient Access of particular relevance for this discussion. In this post, the focus is Eligibility.
As you already know, the variables in Eligibility verification (plan determination, coordination of benefits, patient estimates, pre-service cash collection) often create notable headwinds for achieving the results you desire…the results that not only feed the revenue cycle, but also feed things like employee productivity, employee job satisfaction, and an excellent patient experience and excellent experiences for patients.
While Epic delivers a quality Eligibility verification front-end feature set, optimizing results requires normalization of the data variables coming in. These variables include things like copay amount, service types, payer source (identifying the right Medicare coverage type, determining if a Medicare supplement program exists and applies), payer contract type (this month’s flavor of PPO, POS, HMO, etc.), determining coverage status (active or inactive, primary or secondary), and ID numbers (accounting for and updating changes in the numerical structure and actual number).
As we all know: healthcare is local, which means when you’ve seen one, you’ve seen one. That truth thereby informs the Patient Access work and contributes to why it is important to have:
A collection of proven rule sets that can be further shaped by your unique “community” intelligence (think Waze to Google).
A set of proven workflows that support productivity efficiency and effectiveness, denial prevention, and the highest possible pre-service collection rate.
KPI determination and reporting that creates visibility to performance against goals, helping both doers and leaders in making informed pivots, celebrating victories, and communicating value and/or need for change among colleagues.
So, what’s the moral of the story?
Like Google Maps used Waze to optimize the value of its platform, Epic can benefit from its own Waze for Eligibility verification. The difference here is that healthcare leaders need to find their own Waze ;-). As an Epic “owner”, that’s why you should care.
If you are experiencing challenges in your Epic Eligibility verification work (or aren’t sure) and want to explore optimizing, let me know. I can put you in touch with a Pelitas Subject Matter Expert who can work with you to objectively evaluate your situation to see if there’s opportunity for you and your organization.
Otherwise, stay tuned for installment #2 of the series. We will peek into some of the challenges that healthcare teams face within the Quality Assurance discipline of an Epic Patient Access configuration.
If you could change one thing about your Epic configuration for Patient Access, what would it be? After all the responses are in, you may see a fresh post sharing and analyzing the results. Share in the comments or feel free to email me at firstname.lastname@example.org. If you found value in this post, share it with your colleagues and peers!