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Month: August 2020

Dhana Leal, Director of Sales Operations speaks about her different roles and adapting to pandemic

This month we are speaking to Dhana Leal, Director of Sales Operations about her experience with clients, working for HealthAxis Group, and how she is adapting to a new department during a global pandemic.   
How do our health plan clients benefit from working with HealthAxis Group?

We have a lot of offerings that health plan clients benefit from, but what stands out the most to me is our integration capabilities. With HealthAxis Group, clients can have their analytics and data working for them and connect this information through the software and use it to customize service solutions. In my tenure, I have seen a lot of development and improvements. We are constantly evolving to provide our clients and partners with the latest technology to streamline processes.  

What has been your most rewarding or satisfying experience with our company?  

The most rewarding experience has been to work with so many great teams. This diversity allowed me to learn so much by partnering with individuals who are extremely knowledgeable, proud of their work, and genuinely care about the organization. I find that dynamic to be a huge driver for a lot of the organization’s successes.   

Working side by side with Michele Mahoney and the operations team on projects such as Freedom, Optimum, and Cencal taught me invaluable information about the industry. Furthermore, having the pleasure to guide project management operations was an absolute pleasure. That team’s dedication and eagerness to learn and do things the best way possible was a blessing. On the technology side, I also worked with a group of individuals who I consider the foundation of the organization. The passion of these individuals and their hard work is impressive and admirable.  

How has your experience been through the Covid-19 remote work transition?   

My experience working remotely has been seamless for the most part. I believe it has been a very healthy option for me, saving the daily drive has allowed me to be more productive. Joining a new team in a remote environment could have been challenging, but I have not experienced technical challenges or trouble connecting with people. We use the Microsoft Suite to stay connected, and Teams have proven to be a helpful tool for video calls and file sharing.     

I can take a few breaks throughout the workday that I would not have typically taken in the office because I can work as late as I want or need to complete a goal or task. Unfortunately, a pandemic was the trigger for this shift, and I am saddened by that, but I believe the work-from-home effort to be fruitful to those who work better in such an environment, and I happen to be one of those. 

 

 

Commonly Asked Questions by Health Plans Seeking New Analytics Solutions

Part 3: Analytics Solutions

We complete our series on the most common questions by focusing on our analytics and data solutions. For a quick review, HealthAxis Group offers an array of third-party administrative services that help accelerate productivity, improve processes, and perform cost-efficient operations for Medicare, Medicaid, and commercial plans. We customize service engagements, from outsourcing all plan operations to targeting a single line of service (full list of services).

We understand that choosing a new solution can be a daunting task. To aid in your process, we have compiled the top questions we received from health plans looking for solutions to improve operations and grow membership.

What problems can your solution help us solve?

Our analytics solution is a comprehensive, integrable system enabling full lifecycle analysis. It effectively consolidates and analyzes data into usable and easily consumable information that pinpoints areas for action.

Through our pre-built healthcare Data Model, Data Marts, Intelligence Dashboards, Reports, and Analytics, our system provides hundreds of powerful metrics, alerts, and reports to healthcare professionals. Across the organization, your team can monitor performance, analyze key performance indicators, and compare them to performance benchmarks. Your data will be turned into integrated and actionable insight in near real-time. With Health Intelligence Analytics, you can manage healthcare costs, adopt and become more compliant with new healthcare regulations, improve quality of care, detect fraud, proactively identify high-risk populations and streamline processes.

What type of analytics does your solution offer?

HealthAxis Group’s analytics solution delivers over 200 prebuilt reports and 10 dashboards right out of the box. In addition, the solution allows for customizable and self-service analytics. Providing business users with full ad hoc query and analysis capability, users can create new analyses from scratch or modify existing analyses in dashboard pages.

We provide the ability to turn data into insight using geospatial analytics. Geospatial analytics provide valuable and varied insights into data. The visualizations and interactive geospatial capabilities inherent in our solution are beyond comparison to any like tool. The visualizations deliver detailed analytics in an understandable way that enables the end-users to make informed evidence-based decisions.

Does your solution automate data integration from external/multiple data sources/silos? 

Yes, our data architecture consists of several components that enable rapid data intake, standardization, flexible, scalable, and suitable for data warehouse reporting and analytics. Through our best practice standards, we have built an automated data intake facility (DIF) to easily integrate and automate your data integration. The DIF consists of in-depth data file edits, validation routines, and collaborative interfaces with each data source/submitter to expedite resolutions and standardization of these files. The data intake facility allows for sources and/or data submitters to submit the data feeds with a Graphical User Interface (GUI). During the upload of the data feeds, the DIF automatically identifies errors in formatting, data submission, or failures with the upload. The data submitter is notified of errors and/or warnings to know if the data was completely received. The DIF is the beginning of all data intake and integration and all raw files are stored, backed up, and archived so you always have traceability of who submitted what and what was the original format of these data feeds.

Is your product compatible with my existing infrastructure?

HealthAxis Group’s analytics solution is built on an open architecture and is integrable with any infrastructure or environment.

How do you verify data quality? 

Quality is regarded as paramount importance at HealthAxis Group. This commitment is demonstrated by the development of our quality management and support systems, which will ensure the quality of our products and services. Through our extensive experience with producing an industry best standard for data validation, we focus on three main areas of the data quality process and strongly believe these areas should be developed and supported by the client to ensure a robust data quality best practice. These are Data Terminology, Data Profiling, and Data Governance.

It is our best practice standard to address the following to ensure the absolute best data quality:

Implement fundamental data quality validation routines, including automated processes to notify database administrators of any data load or quality issues.

Conduct Data Profiling to identify data anomalies and outliers. These quality issues would then be routed to the Governance team for resolution coordination.

Implementation of Data Governance and Terminology Standardization is necessary for data consistency and on-going maintenance and improvement.

 

Zachary Kilburn, named a 2020 Tampa Bay Business Journal CIO of the Year Honoree!

We are excited to celebrate our Chief Technology Officer, Zachary Kilburn, being named a 2020 Tampa Bay Business Journal CIO of the Year Honoree!

Zach shared his first HealthAxis initiative in his interview with the Tampa Bay Business Journal.

“When I joined HealthAxis, I focused on breaking down barriers between IT and all lines of business by understanding and identifying fundamental needs, partnering to develop creative solutions, and problem-solving to execute and drive business goals. We recognized that an Agile transformation could bring our organization together under one methodology. Leveraging my experience, we aligned to Agile principles and reshaped the organizational structure and operational functions. Since then, we have seen the organization adapt to market driving forces faster, clear impediments and capitalize on strategic goals.”

Read Zack’s full Tampa Bay Business Journal’s Interview.

Commonly Asked Questions by Health Plans Seeking New Solutions-Services

Part 2: Services Exploration

We continue our series on the most common questions by focusing on our services sector. For a quick review, HealthAxis Group offers an array of third-party administrative services that help accelerate productivity, improve processes, and perform cost-efficient operations for Medicare, Medicaid, and commercial plans. We customize service engagements, from outsourcing all plan operations to targeting a single line of service (full list of services)

With that information, let’s dive into our responses to the services questions frequently asked by health plans.

How do you house and report on the data for 5 Star? And, what support do you offer to help improve ratings?
A health plan’s rating is based on five different category measurements:

  •     Staying Healthy: Screenings, Tests and Vaccines
  •     Managing Chronic (Long Term) Conditions
  •     Member Experience with Health Plan
  •     Member Complaints and Changes in the Health Plan’s Performance
  •     Health Plan Customer Service

We have added specific fields and the ability to have user-defined fields for data capture and reporting of STAR requirements within our core system to make it easy for health plans to monitor all the data points.

Many components factor in supporting health plans to deliver high-quality care and high beneficiary satisfaction. Our in-depth understanding of the healthcare industry and strong partnerships with our clients enable us to provide tailored solutions, best practices, and improvements that address all the different metrics that impact scores.

To start, our senior compliance specialist monitors CMS regulations and oversees the daily MLN, monthly updates, quarterly changes, and all chapter changes. We dedicate and train staff to become an extension of our client’s operations, helping to ensure timely and standardized responses to member concerns and consistent handling of complaints and grievances. Furthermore, removing error-prone processes and harnessing real-time data help improve results.

These are just a few approaches that led our large Medicare Advantage plan partner to grow membership from 12,500 to 150,000 members and improve star ratings from 2.5 to 4.5/5.

What is the experience level of your claims processing staff?
Currently, 75% of our processing staff has been with our team for more than four years and is versed in processes for Medicare HMO, PPO, PFFS, and commercial claims. Our claim processors have extensive training on each specific type of claim and receive ongoing training as processes change. The department has an overall processing quality score of 98.4%.

What is your team’s process for escalating appeals and grievances?
During an implementation phase, the escalation process is explored with your team to ensure each escalation scenario and treatment plan is defined per your plan’s expectations. An instance may occur when a case gets converted from a standard appeal to an escalated appeal or when a case must be handled more urgently or delicately, either due to the member’s medical condition, escalations to regulators or at the request of the health plan. In addition to following the Regulations for Timeliness, we follow the Medical Exigency Standard in which we work to make decisions as expeditiously as the enrollee’s health condition requires. Additionally, the Appeals and Grievances Department will notify your team of those additional escalations and will collaborate through the completion of the case.

Can you handle intake authorization requests from multiple sources (e.g. electronic, written, and live chat via phone)?
Authorization requests can be accepted through various sources. Written requests are accepted via fax or through our mail room services and processed within CMS time guidelines. Telephone requests are received through customer service, provider services, and member services. Electronic requests can be submitted via our real-time provider portal, an extension of our core claims system. A provider can send an authorization or referral request through the provider portal.

What Internal auditing processes can we count on to confirm that the integrity and quality of data storage and reporting are in accordance with State, CMS, HIPAA regulations?
Our data integrity, quality of data storage, and reporting are regularly reviewed by outside auditors to assure conformity with industry standards, including but not limited to CMS and HIPAA. In addition, we work with our clients to understand and address any specific state or client’s needs. Plus, we provide monthly oversight and maintenance reports to our clients.

We hope you found these answers helpful. Our final segment focusing on analytics is on its way soon.  As always, feel free to reach out and schedule time with us to discuss specific questions regarding your unique situation.