By Patrick Birmingham
Lockdowns and restricted hospital access forced many healthcare workers to perform their jobs remotely. Medical staff services departments, administrative offices and credentials verification organizations (CVOs) quickly went virtual out of necessity.
Even before COVID-19, credentialing and payer enrollment (PE) roles in CVOs were viable candidates for a remote workforce. The pandemic showcased what many already knew; these provider data management roles can be successfully performed remotely. While it is too soon to know what work life will look like in a post-pandemic world, one thing is certain—it won’t be the same. The benefits of remote work have been put on full display and it is in demand.
A typical employer can save an average of $11,000 per half-time remote worker per year according to GlobalWorkplaceAnalytics.com’s Telecommuting Trend Data (updated June 22, 2021). Primary savings are attributed to increased productivity, lower real estate costs and reduced absenteeism and turnover. Employees value the flexibility and convenience of remote work.
Whether implementing a hybrid or fully remote CVO workforce, applying best practices will help ensure long-term success. Consider the following tips.
Build an Alignment Strategy
CVOs help healthcare systems verify licensed medical professionals’ qualifications and enroll providers into payer health plans. They do so by accepting delegated responsibility to assess clinicians’ backgrounds, identify gaps and report the findings—either as a contracted third party or as an internal centralized credentialing function.
Regardless of a CVO’s physical location and the provider data management methods and technologies used, the hospital maintains ultimate responsibility for the work performed. As a result, hospitals must ensure alignment when using a CVO that employs or contracts with remote staff.
In any outsourced work arrangement, data management and technology challenges are common. Factor in hastily constructed remote workforce setups, especially amid COVID-19, and a healthcare system’s exposure to risk increases. This is especially true considering CVOs mine and manage provider data used to make essential decisions that affect:
• Regulatory compliance and patient safety
• Successful reimbursement
• Provider data security
• Practitioner satisfaction
• Health plan inclusion and patient access to care
• Organizational reputation
Whether the relationship with a CVO using remote staff is years old or brand new, it’s never too late to examine key data management and technology factors.
Ensure Provider Data Security
Healthcare organizations go to great lengths to protect patient data. This same care should extend to provider data. Ensuring provider data security is the single biggest challenge when credentialing and/or enrollment is conducted remotely. Points of vulnerability exist in every system. For CVOs, key areas include data or document source, viewing authorization, transmission method security and data or document storage (i.e., long-term control).
A key function of CVOs is PSV, which requires going directly to the source of the credential or the institution that issued the document or verifying data through a designated equivalent source. Remote staff or the CVO organization must secure access to other organizations’ hosted data. In addition to collecting provider data for initial appointment, enrollment, recredentialing and keeping practitioners “par” (i.e., participating) on health plan panels, data is used elsewhere. For example, quality initiatives, such as shared savings programs, merit-based incentives, and provider performance management, require provider information. To avoid a data breach, it’s important that remote staff understand where confidentiality lines are drawn.
Additional best practices to minimize provider data security risks include:
• A virtual private network (VPN) routed through the internet from the company’s server or a third-party VPN service to the remote CVO staff
• Multi-factor authentication, whereby the remote CVO staff are granted access only after successfully presenting two or more “keys” to an authentication mechanism (i.e., log-in credentials)
• Data loss prevention software that detects and prevents potential data breaches and allows a network administrator to control what data remote workers can upload or download, transfer and to whom.
Don’t Overlook Browsers
Browser choice (e.g., Google Chrome, Microsoft Edge, etc.) can effect the way information is viewed and tasks are performed, especially when using sites where provider data is catalogued or uploaded via online applications. Consider browser type(s) when collaborating with and training remote staff. Cookies, messages that web servers pass to a web browser when internet sites are visited, can effect performance. Train remote staff about how cookies can affect their ability to upload and download data.
Use a Single Source of Truth Database
A single, shared credentialing database fosters efficiency and security for CVO staff, regardless of physical location. A shared platform that is the single source of truth for all credentialing-related data enables the medical staff office (MSO) and health plans to outsource all or a portion of the credentialing or provider enrollment process to the CVO while maintaining control of the data.
Cloud-based solutions allow access from any location or computer. Managing data across the entire lifecycle of a practitioner fosters the ability to:
• Communicate more effectively in sharing data with all relevant parties
• Ensure data integrity and transparency
• Demonstrate accountability for large volumes of traceable data
• Prepare for inevitable growth
Track Procedures and KPIs
Often it’s not until a problem occurs that internal and third-party CVOs outline specific, detail-oriented policies and procedures for remote staff. Although time consuming, it is a necessary first step to gather information. Document all systems (technological or otherwise) remote staff use to collect, manage and disseminate data and documents.
Reporting on key performance indicators shows ROI and demonstrates the need for additional resources if needed. Best practice tips for procedure mapping and benchmarking include:
• Develop one process to be used by both the CVO and MSO. Eliminate duplication and create a clear and clean path for all remote staff to follow, and train them on it.
• Gauge individual performance metrics for remote staff. Measure multiple data points along the life cycle of enrollment and credentialing to pinpoint problems or delays.
• Track the efficiency and effectiveness of the remote CVO’s processes in measurable terms and dollars and cents. The configuration and reporting functions needed for a remote workforce can become more complex when credentialing/privileging, enrollment and quality/competency assessments all share the same provider data management source.
CVOs perform critical business processes that can, and often do, affect an organization’s bottom line. They require significant technological resources to maintain modern, efficient processes regardless of their physical location. For organizations that lack qualified resources, NCQA-certified and accredited expert credentialing verification services for healthcare and insurance providers can fill this void.
Patrick Birmingham is Executive Vice President, Credentialing Operations at symplr.