Boston Home Health Aides, LLC (“BHHA”), located in Lawrence, MA, is a Medicare/Medicaid Certified Home Health Agency which provides Skilled Nursing, Physical & Occupational Therapy, and Certified Home Health Aides. They offer a comprehensive band of skilled services delivered by the most qualified professional nurses, aides, and therapists in the privacy and comfort of the home.
Process Constraint
The Covid-19 pandemic upended the entire healthcare delivery system and home healthcare was not immune. Already dealing with a tedious ordering process, BHHA needed a better plan to pull required data from their EMR, enter order details, deliver to partners, collect signatures, easily search and follow-up on order status, and quickly access reporting for compliance and re-accreditation.
Using a combination of spreadsheets, manual data entry, and searching for order status was accelerated when the pandemic hit. It was difficult to keep up with all the orders and took too much time to get out the door. Orders were getting lost, and orders were delayed. BHHA was never able to clear out the “To Be Sent” queue weekly.
As BHHA’s census grew, it was taking on average an additional 15 days to deliver orders which exceeded the payor recommended timelines to meet their regulations.
Agency Goals
Boston Home Health was looking to improve their order process due to larger census volume, outdated delivery technologies, wasted administrative time and lost revenue. Unlike many home healthcare agencies, Boston Home Health Aides serves 99% Medicaid and MCO/ACO third-party commercial insurers that get their funds through Medicaid.
Why WorldView?
Boston Home Health Aides (BHHA) has an existing deep integration with Axxess®, a cloud-based enterprise software as their EMR. Axxess is a valued partner with WorldView who has a direct integration with the Axxess solution which simplifies the documentation and ordering process. WorldView offers an intuitive experience by gathering the data right from Axxess and leverages that data to cross reference new records and ordering information saving time by automating BHHA’s day-to-day workload in a compliant and easy-to-use manner.
“The returns implementing WorldView into our business platform has definitely outweighed the investment.”
Root Cause Analysis
Prior to using WorldView, orders were faxed manually using electronic faxing via email. Then, a list of providers that were stored were downloaded into an excel spreadsheet. From there, a calculation was performed to turn fax numbers into email addresses that were used to fax the documents.
The provider fax email spreadsheet was then converted into a .csv filed and mapped into a shared mailbox with all Outlook 365 users and into their contact directory. An email template was created with required fields for orders including date of order, deadline for signature and other payor regulations.
Using the “orders to be sent” queue in Axxess, it was then compared to the plan of care spreadsheet. In the compilation of the email, the fax email for the provider populates and order attachments are added through a drag and drop process. After an order is sent, it was required to monitor the electronic fax notifications for delivery status. Any failed deliveries were manually re-sent through a fax machine.
Any received documentation would be manually entered into the spreadsheet and then manually uploaded into Axxess.
Due to the volume of orders being placed, errors were sometimes made in spreadsheet data entry and orders uploaded into the wrong charts. Finding errors required manually searching through received emails by date to locate misplaced, missed, or misfiled orders.
“Training is simple and allows employees to have control over the data they are accessing.”
Data Informed Action Plan
The WorldView implementation team’s plan included the goal of streamlining the order entry process. The objective was to eliminate the errors that were increasing due to a larger census volume. Some of these errors included incorrect data added to a “plan of care” tracking spreadsheet, and orders were uploaded to the wrong patient charts. In order to fix those errors, employees manually searched through documentation, spending valuable time during the day. With WorldView’s customization option, it allowed BHHA to look outside a single template system and create a priority of features that provide search capabilities as well as a robust reports menu and archiving feature.
Data Informed Performance Improvement
Since the implementation with Worldview, 90% of the ordering process is now automated. A bonus since the integration is that BHHA can also run reports that gives a view into who their top providers are and those that may be slow in returning orders. They can discuss as a team how they can get specific providers to prioritize paperwork, leading to faster return of orders.
Recorded training sessions provide continuity of operations with new staff. With intuitive applications and a dedicated client success team, BHHA never has to worry about getting their questions answered. WorldView provides robust comprehensive training all the way through. Each agency is paired with a devoted account manager that helps train across all departments to meet their specific needs.
The access to on-shore support is also a process benefit – meeting immediate needs, eliminating any communication issues and delays in response due to time differences.
“WorldView is a legacy system you can put into place that will stand the test of time.”
View From the Top with WorldView
Worldview saved 20 hours per week for the BHHA team allowing them to put those wasted hours into other duties with a constricted staff. With more orders getting out of the door quickly, they become more relevant to the providers. Some duties that took a backseat or were delayed due to the long order
process that can now be addressed include insurance audits, compliance reviews, evaluating agency policies and processes preparing for CHAP re-accreditation.
In addition, there is more time for employees to recover orders that are not being returned or delayed for many various reasons. More time could be spent on figuring out issues and contacting providers as follow-up.
Having signed orders in the chart has presented higher levels of compliance due to refaxing and automatic tracking. This gives BHHA the ability to download those orders quickly for review and eliminate issues that may lead to financial recoupment. It also points to medical necessity making the case for providing the care for the patient in the first place.
Compliance with Medicaid conditions of participation has gone from fluctuating between 40-60% before WorldView, to now above 80% – a 20-50% improvement.
Future Opportunities
The results of the WorldView implementation were enthusiastically received by the BHHA staff. With an established, successful partnership, the companies are looking forward to the future with the potential of expanding into a mobile application that leverages custom e-forms.
“The major gift WorldView has given us is the gift of time – we now have time to monitor return orders, stay on top of compliance standards and any corrective action and performance improvement projects making us a more successful company”
The team at WorldView is focused on delivering results & business impact to clients. WorldView provided Boston Home Health Aides a streamlined process that simplified orders and accelerated response and compliance. But beyond the operational win, BHHA has seen a high return on investment, which means an impact to their bottom line
All Quotes by Jason Gauthier Assistant Administrator/Operations Manager Boston Home Health Aides, LLC (“BHHA”) Watch Webinar: How a Home Health Agency Simplified Orders and Accelerated Response Times
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