As lowest cost primary health providers, US Community Health Centers (CHCs) are growing rapidly and are under substantial strain to increase efficiency while providing better access and better outcomes
Traditionally, CHCs have not dedicated significant funds for automation and enterprise performance improvement efforts
Substantial government funding has been made available for automation initiatives
The Problem
A California Federally Qualified Health Center (FQHC) required a means to standardize data, processes and workflows to improve efficiency while preparing for their implementation of an Electronic Health Record (EHR) system, which typically causes a loss of throughput and therefore revenue
Key problems for the organization included patient access, revenue cycle management, patient waiting times, data quality, data visibility, scheduling, and provider productivity
Initial areas of focus: operations, finance, capacity & demand and patient scheduling
Approaches
Consulting-led problem-oriented operational review, including departmental and enterprise analysis of processes and systems
Chief executive-sponsored inter-departmental process improvement sessions
Presentation of clear solutions with staff consensus and buy-in
Enterprise and departmental process development
Prototyping and rapid application development to support new processes
Data quality improvement
Systems integration
Predictive modeling
Solutions
Implemented an organization-wide data quality improvement program concurrently encompassing processes, systems, and staff education
Developed a near-real-time enterprise performance improvement system pulling information from various systems of record
Provided graphical business intelligence system available on management and staff desktops to provide immediate visibility into current state and historical trend analysis
Provided billing staff with up-to-the-minute graphical insight into accounts receivable to identify charge capture deficiencies and take corrective action
Provided scheduling staff with predictive solutions to better match capacity and demand and increase overall provider utilization
Eliminated lengthy manual creation and analysis of paper-based reports through the development of systems-generated exception management alerts
Created a performance data warehouse to accurately record operational, financial and capacity metrics gathered as a result of process monitoring
Results To Date
Data quality improved dramatically whereby key operational and financial reports went from unreliable and retrospective to accurate and real-time
Over $400,000 in unbilled revenue identified that was investigated and captured
Means identified to increase annual retained surplus by more than seven times while increasing net margins from 2.1% to 13.2%
Enabled better decision making by executive leaders due to objective, accurate real-time visibility into operations and finance
Organization better prepared for EHR implementation and integration
Case Study Details
Why TWHS?
Our team has developed medical management systems used by health plans to manage care for over 60 million Americans
Our team has over 100 years of combined experience in international health care operations and information technology
Proven innovation with visually-driven performance improvement systems design, development and deployment
Constant advocacy of proactive management, operations and business automation to identify and solve problems before they become an organizational threat
Substantial experience with systems integration and real-time query optimization with third-party systems
Data quality improvement experience
Rapid business process and application development methodology and technologies
Experience with business-critical timelines where failure is not an option
