As a physician-driven, technology-enabled primary care group, Complete Health’s focus is on delivering high-quality patient care that results in better outcomes while reducing costs. In fact, Complete Health has been ahead of the curve in healthcare’s transition to performance-based care models. Since its inception, value-based care benefits for Medicare patients have been at the core of Complete Health’s primary care philosophy of providing a better healthcare approach to aging.
To deliver on that model, Complete Health’s physicians and other providers focus on the whole patient. They start with a comprehensive, holistic assessment of every patient’s medical conditions and needs, and then develop the right care plan for treatment of acute and chronic conditions. The goal is to improve patients’ quality of life to keep them happy, healthy, and out of the hospital.
For example, reducing patients’ ED visits and hospital stays not only decreases healthcare costs for all, but is essential as part of Complete Health’s goal to better understand its patients and anticipate and address any changes in health status. As a result, the rate of hospital admissions for Complete Health’s Medicare HMO patients is lower (<250/1,000 patients) than the national average (350/1,000 patients).
Complete Health brings together the best physicians and other providers to work as a collaborative team focused on improving care quality, coordination of services, and value for patient populations. Assembling this highly skilled medical team starts with credentialing and enrolling the best new providers to join the group. And as Complete Health continues to rapidly acquire new practices, the need to re-credential and re-enroll providers quickly grows. The end goal: Take the administrative burden of paperwork off physicians so they can do what they do best—take care of their patients.
Credentialing and enrollment are complicated, time-consuming processes, and requirements vary by payer and state. With more than 125 providers each enrolled in 15 to 20 different health plans, the workload could have been staggering for Complete Health. When conducted by healthcare organizations’ internal staff, credentialing and enrollment in Medicare and other health plans can take up to 120 days, delaying reimbursement. When applications bounce back repeatedly due to errors, the process takes closer to 150 days. Meanwhile, providers can’t see patients or receive reimbursement—not to mention the fact that patients are inconvenienced.
“Essentially, Complete Health's investment in symplr CVO paid for itself in weeks,” said Jim Mihnovich, Complete Health's CFO. “We realized an ROI almost immediately and were able to use the savings for other initiatives."
Complete Health selected symplr CVO to handle its recredentialing and re-enrollment for all providers during practice acquisitions, as well as the credentialing and enrollment of new providers who join the group. “It would have been a mistake if we hadn’t used symplr,” said Mihnovitch, adding, “I can’t recall a single mistake made by symplr’s CVO team. When we’re talking about submitting 20 applications each for 125 providers, that’s remarkable.”
symplr CVO’s experts take the stress out of credentialing and enrollment by handling the entire process, including primary source verification and submission of electronic enrollment applications. For example, the dedicated symplr team takes care of recredentialing and re-enrolling each provider for the duration they are affiliated with Complete Health.
symplr’s reporting system makes it easy for the CVO team to keep up with varying recredentialing/enrollment requirements—including re-enrollment timelines/deadlines for each payer. Complete Health’s Medical Staff Office doesn’t have to worry about whether providers are currently enrolled with each health plan. There are no inappropriately rejected claims or delayed reimbursements due to expired enrollments.
According to Mihnovich, "Some of the practices Complete Health acquired initially had reservations about outsourcing credentialing instead of using in-house staff (who were subsequently reassigned to other projects). After the in-house staff saw how quickly and efficiently symplr CVO completed the process, they realized the team’s value and became believers.”
Reaching Strategic Business Goal #1: Growth
Your brand reputation is your organization’s public persona. In a competitive provider market, your health system’s reputation can differentiate you from other groups. Onboarding—credentialing, recredentialing, enrollment, and re-enrollment—is a provider’s first experience with a healthcare organization. If that process is too burdensome and time-consuming, provider satisfaction will suffer. Satisfied providers—and dissatisfied ones—are likely to spread the word to their colleagues, impacting your reputation—and recruitment and growth—positively or negatively.
“symplr has figured out how to be the leader in the complicated field of credentialing and enrollment. Their well-organized procedures standardize and streamline the credentialing process,” Mihnovich said.
Complete Health fulfills its strategic growth goals and attracts more practices and providers by highlighting the ease of onboarding when courting new practices/providers. By investing in an expert, NCQA-accredited CVO with technology that makes the onboarding process quick and painless, Complete Health is better able to attract and recruit outstanding talent. This growth allows the group to deliver better, more comprehensive care to more patients.
- Automates and accelerates onboarding so new providers can start seeing patients sooner
- Delivers hassle-free enrollment and faster reimbursement for the care and services your providers deliver
- Increases provider satisfaction by never asking for the same data twice
- Keeps providers and your medical staff office staff informed throughout the onboarding process
- Provides a dedicated resource to deal with hiccups along the way
“Having symplr gives me peace of mind. I don’t have to worry about re-enrollment and cash flow during the acquisition process. symplr CVO Services is well worth it,” Mihnovich said.