Industry Insights

Introduction
by Lenny George, CEO Cquensys

At Cquensys, we empower health systems automate workflows, implement enterprise-wide credentialing applications, and harmonize data to a single source of truth. As the world of healthcare continues to evolve, we help medical staff offices navigate the challenges of keeping up with rapidly changing requirements and evolving demands. We cover the entire spectrum of Credentialing-specific services, including:

• Strategy Development & Product Evaluation
• Project Management
• Workflow Automation & Implementation
• Data Migration & Expert-level Data Cleansing
• Medical Staff Service and Payor Enrollment Staffing

Our experts also help guide the implementation of enterprise-wide data management programs across various domains, like healthcare and finance. in this edition of ‘expert insights,’ it gives me great pleasure to introduce and interview an industry expert in the field of healthcare master data management (mdm) and provider credentialing– cassie kana carter, cpmsm, cpcs.

Cassie is the recipient of the 2018 hcpro credentialing resource center case study award for medical staff professionals excellence. She is a dual-certified professional with over 16 years of experience working in areas of multi-state medical staff credentialing, payor enrollment and credentialing, and master data management.

Cassie, you’ve worked with healthcare organizations of all sizes and some of the brightest medical staff professionals across the country. What are your observations about the top opportunities to streamline workflows?

The biggest opportunities that still exist all boil down to the need to streamline data. In many health systems, data silos are still commonly found, and they are often the cause of many inefficiencies. For example, several teams within the same organization end up collecting overlapping information, which leads to a substantial amount of rework. If all departments involved in the credentialing process—recruiters, clinical administrators, human resources, contracting, payor enrollment, and medical staff credentialing—used a single data flow, the entire system benefits.

In your experience, how have teams succeeded in making the shift to a streamlined data system?

The key is to connect processes efficiently. The first step to doing so is for all key stakeholders to map the current state of data flow through the organization.

Depending on the size of the teams, the entire workshop can be run smoothly and successfully in a single day when guided by a mediator experienced in credentialing. In larger organizations that operate in multiple states, offer robust enterprise-wide programs, or manage programs at a regional or local level, the workshops may take up to a maximum of three days.

Next, there is a deliberate methodology used to review the process maps and identify pathways for a phased implementation. Sponsors help guide the planning and delivery of each subsequent phase. The above workflow is fundamental for the enterprise to gain an in-depth understanding of the many components required to get the provider to the patient’s bedside in the shortest time possible. It is also a great vehicle to open visibility to other essential needs that teams involved in credentialing have requested over the years.

What is an often-overlooked area that is an easy opportunity?

There are benefits in Minimum Criteria & NPDB Query Data. Recruiting in health systems, even in independently-owned practices, is a workflow that needs streamlining. Recruiters are vital to the system, have a tough job with several challenges, are excellent at cold-call sales, and are often the first impression of your organization to providers.

However, recruiting teams, understandably, do not have the necessary depth of knowledge about credentialing or privileging criteria. As a result, quite often, provider candidates are brought into the pipeline without confirmation of whether minimum qualifications, such as board certifications or case counts, have been met. In such instances, organizations lose time and revenue in recruitment and lost patient care opportunities.

Thank you for sharing your expert advice, Cassie. Any final suggestions for health systems looking to optimize their credentialing process?

I recommend that health systems offer read-only access to credentialing databases for relevant teams. Each department has a separate set of requirements during the credentialing and onboarding process. Clinic directors require current licensing and ACLS expiration dates, and trauma facilities have directors who need Board Certification and Continuing Medical Education information. Administrative personnel require contact information for providers, while marketing teams need basic contact information, and more.

Without access to the right data, organizations waste a considerable amount of time searching for the right data sources. Even worse, sometimes these teams have to turn to information found on the internet, hoping it is current and valid. There is a better way.

There is a lot of sensitive data contained in credentialing databases. How would you go about granting so many people access?

One method, as mentioned earlier, is to set up and enable ‘read-only’ or ‘view-only’ modes based on user roles. These features are now available in most modern-day credentialing applications.

Generic roles can be designed for groups of individuals who need to validate basic information. These teams will be restricted from viewing sensitive data, personal identifiers, peer review content, and other data elements.

These ‘View-only’ or ‘read-only’ (RO) permissions should be audited regularly at intervals agreed upon by credentialing leaders. Contact your local teams who manage and assign access to applications across your organization, as this process can often be integrated and automated to grant, review, audit, and deny access to individuals as required.

Overall, in the long term, allowing RO access can ensure the entire enterprise uses the same data, transition to a self-service mode, reduce overall wait times, and ultimately remove the added administrative burden from the credentialing teams.