Author: Victoria Bucci

Part 2: 3 Keys To Developing A Data Quality Strategy You Can Trust

What good is collecting endless buckets of data if you can’t trust it?

Overcoming skepticism and distrust can only be accomplished through a robust data quality process. Data quality must be at the forefront of any data warehouse and analytics project to guarantee validity and value within the information you receive.

The key is to focus on the three main areas to build a solid data quality best practice standard.

Successful data quality strategies include:

  1. Data Terminology
  2. Data Profiling
  3. Data Governance

Now that we’ve discussed the importance of a sound data governance foundation in part 1 of this series, let’s dive into the importance of data terminology.

Consistent data terminology is critical to building trust and validity in your company’s data and analytics. When data terminology standards are not well thought out, creating one source of truth can be challenging, if not impossible. You cannot compare apples to apples if one set of apples is named bananas.

Standardizing Terms And Definitions Throughout The Healthcare Industry

Having standardized clinical coding standards is crucial for the quality and safety of health service delivery. Most healthcare organizations do not utilize the same business definitions, clinical terminology, or metadata. Meaning the way they refer to health symptoms, diseases, medications, and procedures could be completely different.

It’s vital for patient care and research and development to share data across disparate systems, providers, networks, and applications in a meaningful way. Without data sharing of this magnitude, the healthcare industry will find it hard to evolve into a delivery model based on proactive care management and keeping healthy populations healthy. Without standardized data terminology, the comparisons and analysis are incomplete, misleading, or false.

Data Terminology Best Standards For The Healthcare Industry

The best approach to develop common health terminology is driven through the Data Governance body. Data Governance develops processes and identifies roles that set the corporate direction for setting common health terminology standards. Business plays a substantial role in driving the Data Governance initiative and works collaboratively with IT implementing the specific solutions. There are many sources of government standards to choose from to guide the organization to high-level Master Data Management (MDM). Government mandates like HL-7, EMR, HIPPA, UB forms, and HCFA forms are good sources to begin the conversation around standard definitions and formats to be used throughout the EDW. Based on the direction defined by the Data Governance body, these standards are implemented through the data modeling processes during data acquisition.

When there is trust within data, users have the confidence to take action based on that data. Without it, there is no action and lack of action is death to any analytics solution. A data warehouse and analytics solution are only as good as the actions they evoke. Data terminology standardization across data submissions is paramount in developing your data quality strategy.

The final blog will dive into best practice standards for data profiling to strengthen your data quality strategy.

 

Cyrus Jovan Chats About Project Management

This month we speak to Cyrus Jovan, Project Manager, about his experience with clients, working for HealthAxis, and utilizing Agile methodology to empower teams to make decisions and facilitate communication internally and cross-departments. 

 Tell us about your team and daily activities. 

The Project Management Office (PMO) is responsible for managing both implementations and HealthAxis scrum teams. Project Managers coordinate internally with our project teams and externally with the client to ensure their projects are successful. In addition, our department also leads our internal scrum meetings, which are meetings teams use to produce products faster by breaking large development projects into smaller pieces. As scrum masters, we act as facilitators to remove impediments and meet sprint goals every week. 

 What does an average day look like for you / your team?   

The Project Managers (PM) and Scrum Masters (SM’s) will both have busy days; however, the PM is mainly on client-facing calls addressing requirements outlined in the Statement of Work (SoW). Each project is unique and encompasses a distinct set of requirements. Different working areas of projects have their own set of meetings with internal and external resources. These meetings determine issues or risks and facilitate progress, allowing us to meet the project’s correlated milestones. Scrum Masters are HealthAxis resources that manage assigned scrums and set expectations on a bi-weekly basis. Scrum masters conduct successful sprints by hosting planning sessions, daily stand-up meetings, and Sprint Retrospectives (lessons learned). They also follow up with resources daily to ensure progress and to assist with impediments. 

 Do you have any exciting upcoming projects?  

As the Cherokee Indian Hospital Authority (CIHA) implementation Project Manager, I am personally looking forward to the 7/1/2021 Go-Live. Monitoring that all items are complete, tested and that a successful transition occurs both internally and externally for the implementation is always an exciting time in the project life cycle. While all projects are unique, this implementation represents the very first Tribal Option (TO) hospital in the country to become a stand-alone health plan sponsored by the North Carolina Department of Health and Human Services (DHHS) and will be the first to offer medical services under the TO umbrella for the Cherokee Nation in North Carolina. Therefore, it sets the standard for future Tribal Options in other states for other tribes and their respected state DHHS.  

 What has been your favorite memory so far with HealthAxis?  

My favorite memory at HealthAxis involves the many occasions where our backs have been against the wall and our team worked together to complete the task at hand. Whether it be changing scopes or shifting dates, we always work together to accomplish our end goals. 

 

HealthAxis’ Flexible Work Options are Here to Stay.

For years there have been debates and hesitation for companies to transition to remote and flexible work options. In response to the pandemic, HealthAxis rapidly adopted new behaviors. Our teams quickly pivoted into a hybrid work environment thinking it would be a short-term solution for keeping everyone safe. Now, we have realized this shift has become the future of our workforce. Many experts believe the hybrid model and work-from-home options are becoming the expectation for jobseekers and existing employees. Companies that choose to deviate from this model could be putting themselves at risk for higher turnover.

Pandemic Inadvertently Grew Employment Pool

After assessing the industry trends and as part of our intentional growth strategy, HealthAxis has permanently embraced the flexible, remote-work model. This design offers employees more flexibility and freedom, giving them more control over how they work and where they work. Over 95% of our job openings are now location-agnostic within the United States.

Individuals can choose how they do their work the best— at home, in a corporate office space, a combination of both, or even working in a state outside our core cities. The exact mix of home and office work mode is a decision each employee and their manager will agree to together. This approach allows us to remain competitive and builds an even more talented, diverse workforce as we hire from increasingly different backgrounds and perspectives.

HealthAxis Addresses Work-From-Home Downfalls Head On

We understand some of the biggest challenges to remote work are communication gaps, lack of social interactions, and employee motivation. Addressing these challenges, HealthAxis revamped our new hire orientation and training programs to reflect a remote-first onboarding experience incorporating an expanded library of virtual training. In addition, HealthAxis enlarged the HR team to heighten the remote employee culture and keep our team connected, engaged, and active. The staff is in the process of growing the employee engagement committee, upgrading the wellness program, increasing activities on our Teams channels, and evaluating in-person collaboration and team gatherings.

Furthermore, our new hoteling policy allows employees to work in our offices and have group meetings by simply reserving a space for their needs. The team is still developing and improving upon many HR policies like protocols for hiring and retaining employees living outside our core operating areas and updating payroll and tax guidelines.

HealthAxis Core Values Support Adjustment to Remote Work Environment

Following our Core Value of Intentional Growth, we have embraced this evolution into a hybrid, remote work. “We believe this is an opportunity to redesign the way we work for the betterment of present and future employees as well as the company. We know we may not get it 100% right immediately, but we are committed to maintaining a learning mindset. Our Core Value of Controlled Experimentation and Applied Learning is about staying open to new information and feedback and iterating over time until we do”, said Shilen Patel, CEO. “Our goal is to expand access to the opportunities that a career with HealthAxis represents.”

HealthAxis to Take Part in RISE Special Needs Plan Leadership Summit

HealthAxis is exhibiting and speaking at RISE Special Needs Plan Leadership Summit

Date: June 22-23, 2021

HealthAxis will be showcasing how our team can help overcome the complexities of the Special Needs population with our comprehensive integrated solution, HxOne, comprised of innovative technology, extensive services, and actionable analytics.

Visit us at our booth or join us on Wednesday, June  23rd at 1:30-2:15 pm during the Boosting Clinical Outcomes through the integration of Behavioral Health session.

Alex Morrison Explains Software Architect’s Responsibilities

This month we are spending some time with Alex Morrison, Solutions Architect to learn about his daily activities and team accomplishments and challenges in the past few months.  

Tell us about your team and daily activities. 

The software architecture team supports multiple aspects within the company from leading user story design reviews to developing proof of concept initiatives. Working in a collaborative setting, we tackle topics and lay the groundwork for client incident response, provide technical design, document and develop technical initiatives and move current implementations forward. We work through a multitude of detailed tasks that support development within our company.   

What exciting implementations and developments are coming up?   

The scrum teams are currently working to implement CMS Interoperability using the Fast Healthcare Interoperability Resources (FHIR) standard. This protocol facilitates a streamlined exchange of data between healthcare entities. Outside of Electronic Data Interchange (EDI) standards like 834, 835, 837, etc. information is exchanged using proprietary files or Application Programing Interface (APIs). FHIR conforms all the data into a common format allowing all systems to speak the same language. Once fully adopted, the increased efficiency will significantly increase our velocity for many activities like reporting and client implementations.  

We are currently working on the methodology of microservices. Once implemented throughout our team, our large products will be broken down into manageable, scalable, and reusable components. This way, each microservice can move at its own speed instead of being held up by the slowest component.  

What wins or challenges have you/your department recently had?  

One of our new technical initiatives recently made it to production. During a client implementation, we introduced single sign-on and multifactor authentication capabilities to HXPro, HXLogic, and Care Manager products. This capability utilizes the vendor Okta to greatly increase our application security and allow our clients to easily transition between our products as needed.  

What do you value most about our culture and recognition programs at HealthAxis?   

I value that we have an active culture. My prior companies either had no culture or it was not reinforced. HealthAxis puts a lot of effort into making sure our values and goals are known, so everyone is pushing in the same direction. I think that effort is visible in our accomplishments and how we can tie actions back to these core concepts.  

We recently had Employee Appreciation Day where I received an award for representing one of our company’s core values. To be recognized by peers and management for exemplifying a core value of the company is humbling. 

Developing Care Management through Analytics

In today’s healthcare climate, where pay for performance and shared savings models are the new norm, using analytics creates the blueprint for sound care management.  

The entire healthcare industry has realized the importance of analytics. Using real-time data to make evidence-based decisions has been a game-changer. Applying analytics has driven costs down while simultaneously improving the quality of care. This is an irrefutable fact. However, many organizations are still underutilizing the data within their possession.  

Most only look at the data once engaged in a care management program (which beneficiaries need case management, outreach, etc.). While this is vitally important, many miss the potential to construct the most efficient program for their population from its very inception. Data can guide program development to better meet the needs of the population, drive larger and more immediate savings, and deliver better healthcare to patients. 

Developing an Effective Infrastructure 

Data should be used to determine the core infrastructure of your care management model. The same data points used to administer care can also be used to develop an effective infrastructure. For example, information such as the total volume of beneficiaries in need of care management help determine adequate staffing when setting up your care management model. A care management model cannot improve the quality of care and positively affect outcomes with inadequate staffing. 

Analysis of your population will also guide the type of staff required. Data points such as the number of beneficiaries with a chronic disease or those needing a PCP will determine the level and education of care managers needed. If your population has a higher percentage with chronic diseases, a higher-level education/skill may be needed to coordinate care. 

Customizing Analysis of Your Data 

Having the ability to easily customize the way you view your data can be the difference between meeting the CMS shared savings threshold or falling short. HealthAxis’ pre-built ACO Analytics solution enables the use of over 100 pre-built analyses developed around CMS standards and easily allows for self-service, ad-hoc, and custom analytics with just a few clicks.

 FREE Proof of Concept Using Your Data 

Utilize your own data and see what insights you might be missing. Use our online analytics solution for FREE for 30 days.  

Get Started Today 

Runi Patel Speaks About Her Role and Team

This month we are spending some time with Runi Patel, Health Operations Business Analyst, to learn about her team, daily experiences, upcoming implementations, and what she values about our company culture.  

Tell us about your team.

Our department is one of the most versatile in the company. Most of the materials for Providers and Members are in some way touched by our department. While CMS provides a lot of guidelines, they do not provide the “how to.” That is where my team comes into play. We work closely with most if not all teams at HealthAxis to ensure materials are mailed to help keep the clients in good standing with CMS. My team consists of a diverse group of well-rounded people with experience in Health IT, Public Health, Academia, Finance, Business, and more. Our team, while only 2 and a half years old, plays a pivotal role in our organization. We work together with an efficient teamwork strategy to meet the needs of our clients.   

What does an average day look like in your role?   

One of the things I love most about my position is that no two days are the same. Every day there is something different to work on and work towards. It is one of our company’s approaches for process improvement. My day deals primarily with the implementation of claims payment fulfillment payment. Our electronic processing method allows providers to receive payments on the same day. Other days, I handle day-to-day troubleshooting, update requests, and other special projects that I can get my hands on.   

What is new and exciting in your department?   

One of our upcoming process implementations is conducting member-facing and provider surveys. Thus far, a project like such has not been implemented. It is truly empowering to see how open the leadership is to begin working on this project and scoping to understand the unknowns. With a background in patient satisfaction, I am playing an instrumental role in this implementation. By conducting these surveys, the client will have the ability to improve their processes by providing better health and resources to their members. Essentially, we are pioneering better health for the members.   

What do you value most about our culture at HealthAxis?

I value the employee-focused culture. Every few days, communications and new programs are released to encourage employee development. They vary from focusing on physical and mental health to personal and career development. While remote, we are still able to feel like we are a part of the big picture. 

Julie Williams, Client Services Account Manager – 20+ Years Experience

This month we speak to Julie Williams, Client Services Account Manager, about the many facets of her role, what she finds rewarding in her position, and what progress she has observed over her two decades with HealthAxis.  

What does the day of an account manager entail?  

Every day is a little different. I have a multitude of tasks within client services for various products and platforms. My clients are all unique and are contracted for multiple products, including front-end data capture, custom workflow for document management, claims and administration, 1095 Affordable Care Act web portal, and more. In a single day, I navigate between answering client questions, working on tickets, supporting demo requests, and developing workflow designs or specification updates.  

What do you find most rewarding in your work?  

I enjoy making clients happy by resolving their challenges and supporting the growth of their operations. We have seen this in many partnerships over the years but, I find one of the most exciting and evolving is the prison systems support organizations. These groups who provide care for inmates have been a unique opportunity for our company and continues to be an area where we expect further growth. They use our services for claims processing support, data capture, scanning for payments, and more. We help them to meet federal, Medicare, and other requirements necessary in this space.   

What are your most memorable times with HealthAxis and, how have you seen the company evolve?   

I have been with the company for 23 years and have had many great experiences personally and with client successes. Some of my favorite times have been out on the road with my colleagues visiting and developing client relationships. I was lucky enough to go to Jamacia twice when we had a data capture facility there. Once in North Dakota, we took a day to see Mount Rushmore.    

In recent years, we have seen an evolution in our culture driven by our CEO, Shilen Patel. The thing I admire most about him is his approach to inclusion with open and honest communication. As Covid began to challenge the United States, our executive team jumped into action by moving anyone who could be to remote work. I appreciate the safety precautions but, I do miss our in-person interactions. Should we return to the office, I’m most looking forward to the return of our workout group in Dallas. 

Direct Contracting: What Organizations Need to Consider

The Centers for Medicare & Medicaid Services (CMS) Innovation Center will implement its new Direct Contracting model on April 1, 2021, leaving room for potential delays due to the coronavirus (COVID-19). The Direct Contracting model is a voluntary, value-based payment model that encourages physicians to take higher levels of risk for greater potential reward for their Medicare patients.

The Direct Contracting model requires participation of capitation and includes the opportunity for practices to have few, if any, Medicare fee-for-service (FFS) patients. An implementation period (IP) will allow practices additional time to align their FFS patients for this new model.

To allow more time for implementation, CMS has made other changes to the Direct Contracting timeline, which include:

  • Practices that applied by February 25, 2020, may participate in the IP beginning on October 1, 2020
  • The Innovation Center is accepting applications from June 4, 2020, through July 6, 2020. Organizations may apply here
  • The Innovation Center announced a second round of Direct Contracting adoption that will begin January 1, 2022. Applications for this may begin around spring 2021.

This adjusted timeline will allow organizations more time to assess the Direct Contracting model and decide if they want to participate. As COVID-19 exposed flaws in the current system, models like the Direct Contracting model, which include capitation payment and funding, may become more attractive to healthcare organizations.

Key Points for Organizations Considering the Direct Contracting model

The organizational structure of the Direct Contracting Entity (DCE) and capitation payment mechanisms
Under this new model, participants will submit claims to CMS for services, and CMS will reduce the claims payment amount to $0. They will then make the capitation payment for those services to the physician or practice. With this model, the cash flow may vary depending on the organizational structure of the practice.

Financial exposure for DCEs is larger than previous Innovation Center models
The Direct Contracting model comes with numerous discounts and withholds generally applied against the performance year benchmark. The overall impact of these discounts and withholds may represent significant risk exposure for DCEs. The organization should evaluate the level of risk and opportunity before choosing to participate.

Direct Contracting is missing critical payment details
CMS says it will use an adjusted Medicare Advantage ratebook to calculate payment for Direct Contracting and a risk adjustment methodology, but these have yet to be specified. Some organizations may benefit from waiting until more details are released.

State regulation of risk-bearing entities
The licensure requirements regarding risk-bearing entities are different in each state. The Direct Contracting model requires that DCEs are in compliance with their state’s laws, which could create burdensome tasks for DCEs.

Voluntary alignment may lead to promising results
Direct Contracting is testing voluntary alignment in traditional Medicare, encouraging patients to take a more active role in their healthcare, especially when choosing a provider. CMS is providing additional tools, such as dental vouchers, wellness memberships, and phone apps to help align other benefits currently available in Medicare Advantage.

Contact HealthAxis by filling out the form below to learn how our products can help you navigate the Direct Contact Model.

Coronavirus Update

As the coronavirus (COVID-19) continues to impact the global community, we are taking measures to ensure business continuity for our customers, employees, partners, and other stakeholders.

HealthAxis Group is committed to maintaining high-quality customer service. Our business plan provides for uninterrupted operations and customer support.  All established channels of communication will remain open.

As a precautionary measure and for the safety of our employees and clients, we have implemented a hybrid work model and restricting non-essential travel.  We will continue to monitor the situation as it progresses.

We hope that all our communities stay safe and healthy.