Admin automation helps Proactive MD save an FTE per clinic, expand to 12 more states

Headquartered in Greenville, South Carolina, Proactive MD has a total of 63 health centers and serves approximately 60,000 patients across several states. Proactive MD’s mission is to offer high-quality, low-cost primary and preventive care directly to employers in onsite and near-site clinics.

“We’ve pioneered a form of direct primary care called advanced primary care,” said Jeremy VanderKnyff, executive vice president of health data science, value and validation, at Proactive MD. “Like DPC, Proactive MD’s care model empowers physicians to practice broad-scope primary care. Members come to our clinics for everything from routine annual check-ups and health screenings to nutrition counseling, acute care and vaccinations.”

The provider organization partners with companies to provide primary care and other clinical services designed to decrease costs, manage risks and maximize healthcare benefits.

“Understanding that employers are an important part of the healthcare marketplace, we developed solutions that improve access to care across rural populations by combining multiple employer groups under a single health center,” he explained. “Additionally, we welcomed non-employer sponsored patients to become ‘retail’ members at our health centers, further expanding care to communities.”

THE PROBLEM

Combining so many employer groups under one roof introduced complexity that required a solution – one that would be invisible to patients and physicians yet precisely support the nuances of different employer plans.

Additionally, Proactive MD’s integration needs – such as tying into the EHR, syncing dozens of member eligibility files and powering advanced analytics – called for a more scalable, tech-enabled solution than manual processes, spreadsheets and scrappy workarounds.

“As we grew and scaled our operations, it became increasingly complex to keep track of membership details, eligibility and what to charge,” VanderKnyff noted. “Clinic staff collecting payment at time of service would have to look at one spreadsheet to see a patient’s eligibility and payment structure, and collect and track payments in a separate system. It was a 12-step process just to say, ‘This is what you owe today’ and collect the payment.

“DPC practices considering contracting with employers to expand their business should know that complexity can increase exponentially compared to consumer members.”

Jeremy VanderKnyff, Proactive MD

“We also faced unique challenges associated with managing many small and medium employer groups under one roof. Not only is each employer plan unique, but even within employer groups there are internal complexities, like a university offering different benefits for faculty and staff.”

Further, smaller employers often do not have the internal resources to stay on top of changes to their employee rosters, which can lead to billing mistakes in both directions, he added.

PROPOSAL

Proactive MD turned to the Hint Health platform, HintOS, which alleviated much of the complexity of multi-employer direct contracting by providing a seamless way to securely handle member enrollment, employer plan administration, eligibility management, billing, invoicing, payments and collections, VanderKnyff explained.

He added that this represents a networking system that practices need to have to make a DPC model work effectively.

“By reducing the burden of these administrative tasks, Hint ensured that our clinicians and care teams could spend time with patients instead of tied up with paperwork, ultimately creating a well-rounded system that takes the hassle out of practicing medicine,” he said. “That also allowed our analytics team to identify accurate and timely insights.

“We align our entire company behind our patient promise: ‘We are only and always about the patient, and promise to always fight for their greatest good,'” he continued. “That promise extends well beyond patient care into every aspect of our company.”

For the technology and data teams, that translates directly to both safeguarding the privacy and security of patient records and creating a seamless process for onboarding new patients and enabling them to access care.

“Hint was built for compliance with ISO27001 and SOC2 Type 2 data security certifications,” VanderKnyff explained. “They had also built a powerful Eligibility AutoSync engine that integrates directly with third-party administrators and employer HRIS systems and our advanced plan administration features, giving larger, more sophisticated DPC practices like our own capabilities to wrangle hundreds of inbound data connections into a smooth eligibility, enrollment and patient onboarding process.”

MEETING THE CHALLENGE

Hint’s technology was used in several different ways to streamline Proactive MD’s back-end operations.

The platform created bi-directional integration with the provider’s athenahealth EHR. This proved to be critical since the clinical staff live and die in the EHR system.

“Every extra system that they need to log into is extra work and makes the process cumbersome and clunky,” VanderKnyff said. “But with Hint, clinicians and administrative staff are always operating off the same, up-to-date member information across systems.

“Data has to be changed in one place and it flows in both directions,” he continued. “The data coordination between Hint and our EHR provides better data integrity that ensures accurate, up-to-date, non-duplicative information across all of our care delivery systems.”

One of the ways the new technology has helped Proactive MD tackle the complexities of managing a nationwide footprint of practices is that it has allowed the provider organization to keep track of all the changes to member eligibility and personal information, which was once an error-prone and time-consuming process involving multiple teams.

“The platform’s Eligibility AutoSync feature empowered seamless automatic updates to employee census files, including eligibility status and changes to personal information,” VanderKnyff said. “Today, more than 75% of all Proactive MD members are automatically synced and processed through the Eligibility AutoSync engine.

“Other ways the platform has supported us are allowing us to easily and automatically invoice either the patient or sponsor, depending on the specifics of the member’s plan, and having a centralized list of charge items that streamline both the patient experience and the implementation of new health centers.”

Hint also is an active participant in the national DPC movement, he noted.

“They’ve been good partners with our unique and multifaceted membership-based model, collaborating with us on operational challenges we experience as our company continues to scale by creating new integrations and features that meet the ever-evolving demands of our practice model,” VanderKnyff explained.

“Hint approached us with a solution mindset, rather than a fixed conversation,” he continued. “Everything we spoke about was up for discussion. There was always this openness of how to create a solution that solved problems specifically for Proactive MD, and that generated a tremendously collaborative end product.”

RESULTS

Since using the new technology, the results have been impressive, VanderKnyff explains here:

  • One FTE headcount saved per clinic per month. Prior to using Hint’s member management and EHR integration across the entire organization, calculating member engagement – one of the most important metrics – could take hours for a single employer or health center because members had to be manually matched across systems. Now, staff can calculate that metric for every employer and health center in seconds, a savings of hundreds of person-hours each month.
  • More than 200 hours saved processing and analyzing membership data each month. No longer do staff have to mine 50 spreadsheets to find what they need. The new platform improved the overall patient experience, like check-in and checkout. It improves the efficiency for the office and clinical staff trying to manage administrative work.
  • 20% growth in the number of health centers opened in 2021. Proactive MD has actively expanded to 12 additional states in 2021. Rapid growth and simultaneous health center implementations are made possible by centralized, automated and efficient processes – one of the most vital being eligibility management handled by Hint. Through the Eligibility Autosync feature and its direct integration with the EHR, staff can enroll thousands of patients in a matter of minutes and immediately begin building the relationship between providers and patients.
  • An average of $415 saved by employers per employee annually. Proactive MD prioritizes the provider-patient relationship. Technologies like Hint allow the organization to focus on patient care and not back-office administration. The primary care model was twice validated by the independent Validation Institute for demonstrated cost savings – the only employer-sponsored primary care organization to achieve that distinction.
  • 95 net promoter score among members. Proactive MD’s average appointment is 30 minutes long – 30 minutes of the provider’s undivided attention, focused solely on the patient and their wellbeing. That standard of primary care only exists when the noise and hassle of back-office and administrative operations are stripped fully away from the provider-patient relationship and the patient experience is seamless from start to finish.

ADVICE FOR OTHERS

“DPC practices considering contracting with employers to expand their business should know that complexity can increase exponentially compared to consumer members,” VanderKnyff advised. “Employers investing in a primary care solution expect a seamless patient experience, detailed analytics and reporting on both the utilization of your service and the value it’s delivering, accurate and timely invoicing and payment collection, and a turnkey solution that minimizes their efforts.

“Investing in a membership management platform and automating as many of those tasks as possible will make the transition to employer-sponsored plans that much easier to manage,” he concluded.

Twitter: @SiwickiHealthIT
Email the writer: bsiwicki@himss.org
Healthcare IT News is a HIMSS Media publication.

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