CareMount Medical is the largest independent multispecialty medical group that provides comprehensive medical care to more than 550,000 patients across more than 40 locations in New York. This medical group also is affiliated with organizations including Massachusetts General Hospital, Mount Sinai Health System and Memorial Sloan Kettering Cancer Center.

THE PROBLEM

Like many healthcare organizations, CareMount has known for some time that value-based care is on the horizon. And while it has been expecting reimbursement models to change, it also is aware that provider organizations are compelled to make substantial investments to be successful under value-based care.

This challenges organization leaders to balance priorities and maintain profitability in this transition period and into greater value-based models.

PROPOSAL

CareMount has been working with health IT and services vendor IKS Health in many ways, but at the core is a two-solution strategy that is enabling the organization’s transition from fee-for-service to fee-for-value.

“First, for the last few years, IKS has entirely managed our revenue cycle services,” said Kevin Conroy, CFO at CareMount. “One of the early successes was reducing our overhead on costs such as salary, equipment, training, technology, etc. We’ve also improved collection results – collecting more patient-responsible payments, resolving any issues that were causing repeat rejections, reducing the DSO to ensure we had more cash on hand – all of these things have ensured that we are optimizing revenue today so we can prepare for and invest in tomorrow.”

The next strategy has been to focus on coding and reporting. While the provider organization’s adherence to compliance is excellent, the coding expertise at IKS Health has been helpful in capturing the current health status of the organization’s population and the ability to improve patients’ conditions, Conroy explained.

“This will ensure our successful future in Medicare Advantage and our future as other fee-for-value programs expand,” he said.

MARKETPLACE

There are many vendors on the market that offer revenue cycle technology and services. These vendors include Altruis, Cerner, Enhanced Revenue Solutions, Kareo, Parathon, Phreesia, Signature Performance and Waystar.

MEETING THE CHALLENGE

CareMount Medical has been meeting the challenge of transitioning to value-based care on three fronts: people, process and technology.

“On the people front, for our organization, IKS builds a unique center of excellence,” Conroy explained. “A group of people specifically dedicated to our organization and our contracts. We have our own training and succession planning within that team. Operating as an extension of our team, IKS has the expertise and ability to scale at a cost-effective rate which we were unable to develop on our own.”

"At any moment either myself or any other senior leader can look at the organization, clinic or provider view of performance and make decisions accordingly."

Kevin Conroy, CareMount Medical

When it comes to process, Conroy said that IKS brings expertise regarding revenue cycle that spans the industry. Supporting dozens of clients, employing thousands of individuals who all are working in revenue cycle, IKS has developed an intensive training program and operational best practices that bring a standard way of working to the CareMount team, he added.

“Something that we saw happening within our own organization is that as we grew, we struggled to recruit and retain enough individuals with experience within our own geography,” he said. “That meant we had to either recruit in – and subsequently pay more for that – or we had to train. Training is possible, but we found that without the outside expertise and perspective, we were only as successful as our best employee.”

And in the technology arena, there are two technologies that facilitate CareMount’s work with IKS.

“The first is an executive-level dashboard that gives real-time reporting of our cash on hand,” Conroy said. “This means that at any moment either myself or any other senior leader can look at the organization, clinic or provider view of performance and make decisions accordingly.”

The second technology is called Optimix. This proprietary tool enables CareMount to manage its workflow so that at a given moment, the organization is maximizing the day of each worker by prioritizing down to the specific claim and payment opportunity, he explained.

“Additionally, IKS and our EHR vendor have had a long-standing partnership,” said Conroy. “IKS is not only a power-user of our EHR, but has programmed and created segments of their upgrades over the years. This simultaneously frees our users from the system, and ensures we are collaborating with all stakeholders who have institutional knowledge and expertise beyond our organization.”

RESULTS

CareMount’s first success came from cost reduction.

“Thanks to the IKS global delivery model, we were saving the salaries, benefits, employment tax, equipment technology and more on this work unit,” Conroy said. “Moving to a strategic partner saved us these expenses, resulting in a 25 percent reduction in our total cost to collect. This freed up capital to invest in other strategic initiatives.”

Then there was cash acceleration. In addition to the cost reduction, CareMount experienced improvement in its cash collection. By improving first-pass payment ratios (said another way, by reducing claims denials), and by improving accounts receivable resolution rates, CareMount has been paid nine days sooner than when it was managing this process by itself.

And there has been a revenue upside. When comparing like-on-like charges from the organization’s pre-IKS and post-IKS days, CareMount has seen an improvement of total collection of 1.5 percent.

ADVICE FOR OTHERS

“Organizations should consider looking for a partner with a comprehensive understanding of healthcare that is able to offer a multi-solution, comprehensive approach to their challenges,” Conroy advised. “I think so often we see organizations stretch themselves thin when it comes to partnering with several vendors. This can put you at risk regarding compliance and security at a time when ensuring the privacy of protected information is more critical than ever before.”

And consider the impact of allowing a partner to focus on revenue cycle, he added. That has allowed CareMount’s team to focus on other critical initiatives such as value-based care and patient support, and to be an innovative healthcare organization, Conroy said.

Twitter: @SiwickiHealthIT
Email the writer: bill.siwicki@himssmedia.com