MERCURY ADVISORY GROUP
International Healthcare Management Consultants
CASE STUDY - PROJECT REPORT
Health Travel Coordinator Pilot Program Enhances the Patient Experience at Health Travel Destination Hospital By MARIA K TODD, MHA PHD Introduction and Overview The scope of the project engagement was to develop the role and programming for a “Health Travel Coordinator” position to expedite care when needed, and fill in when gaps occur in the episode of care, in order to improve the health travel patient experience. While health travel to an academic and research hospital is not new, hospitals are now more committed to delivering on promises of brand excellence from stem to stern. This is especially true more recently in the face of measured performance under programs such as HCAHPS® and other quality and customer satisfaction monitoring and evaluation programs required by health regulations and third-party payer performance-based compensation arrangements. Often, hospitals and health systems engage Mercury Advisory Group consultants to develop programs that can enhance coordination of care practices to enhance brand touch points and to negate gaps in service created by multiple hand offs, and to quickly recover from customer service mishaps that can occur along the way. Defining the Health Travel Coordinator’s Role
In order to promote the Ideal Patient Care Experience and to pilot improvements in coordination of care, an academic teaching and research hospital engaged Mercury Advisory Group to created Destination Health Coordinator’s Office to manage and highlight several clinical programs that were above average in coordinating care. These service lines had engaged physicians, and were willing to spend the time and effort to pilot new models for improving the healthcare experience. The Health Travel Program then wanted to pilot an initiative that would coordinate care between multiple departments and produce increased patient satisfaction and higher HCAHPS® scores. Mercury Advisory Group consultants were engaged to create a pilot program for an academic teaching and research hospital that featured a health travel coordinator role. In the pilot program, each arriving health travel patient would remain connected to their assigned coordinator(s) from arrival through departure, and engage at specific touch points along the care path to ensure a seamless and coordinated experience. Touch points were selected based on a previous engagement with Mercury Advisory Group and resulting patient and family feedback and past patient experience mapping data.
Past efforts in Care Coordination Coordination of care efforts were previously tested in many service areas, including, but not limited to primary care, gerontology, cancer centers and even under the U.S. Medicare Demonstration HCAHPS® project, but not under “specialty care models.” The goal was for this position to act as the patient-centered link to all touch points in the episode of care. The objective was to ensure that coordination within the Health System is smooth and seamless for patients and their families and guests as they travel through the multitude of care handoffs within a complex health system at a large academic and research health facility. Pilot Program Development Rather than attempt complicated change management all at once, our client engaged us to develop and execute a strategic pilot program in order to first analyze and measure the amount of coordination of care that would be necessary to successfully scale the program. We suggested that the client include key performance metrics for an activity-based cost analysis so that the feasibility of scaling the program could be analyzed from
an increased costs and ultimately a transparent pricing perspective. For years, academic institutions have incurred these costs as part of their inbound health travel care coordination, but never had the data to defend that the health plan reimbursements were woefully inadequate to cover this incremental direct cost associated with health travel care coordination for patients referred to the academic and research hospital from remote areas where only critical access hospitals (CAHs) were available, but incapable of meeting the health plan subscribers’ needs. Instead, health plans have always colored their comparative fee schedules as merely “higher” without valid explanation. This data would create more reasonable and defensible case pricing costs with regard to bundled rates and risk-sharing arrangements for patients referred to healthcare shortage areas where comparable services are otherwise unavailable. Deliverable By incorporating these observations and metrics, the pilot program would benefit the hospital in five ways: (a) development of actual cost data by procedure / by specialty; (b) monitoring and analyzing best practices and areas for improvement; and (c) ways to enhance the overall patient experience with the brand in the health travel referral setting. The latter would also help the hospital to (d) scale training and development and (e) plan and execute successive program roll out to other departments. The pilot study was able to bring to light how care coordination could also enhance internal customer services to contracted and referring physician partners in remote areas. Some of the metrics were designed to give insight about other service enhancements that may have otherwise been overlooked. The goal was to produce a cohesive and patient-centered program that would integrate efforts between direct patient care, diagnostics and other ancillary departments to fill in any identified gaps, reduce waiting times, speed up reporting of results, reduce costs, and enhance the human factors linked to compassionate services to patients and family members and guests. Tools and Methods A comparison map of care coordination was developed to explain why some clinics were better coordinated than others and identify root causes of any system inefficiencies. We successfully deployed a LEAN “D-M-A-I-C” (an abbreviation for Define, Measure, Analyze, Improve and Con© 2013. Mercury Advisory Group. All rights resrved.
trol) approach for this exercise. We utilized a cloud-based business process management tool available from IBM BlueWorks Live to map the operational decision management (ODM) processes remotely. this enabled us to be good stewards of the client’s financial resources and reduce consultant travel costs and time onsite. Mercury Advisory Group frequently uses BlueWorks Live to save clients time and money and deliver faster, more granular results in its business process engagement deliverable. We initially designed the pilot program with a referring partner hospital. The expense of the Health Travel Coordinator’s position was allocated to referrals from the partner hospital. Cost accounting for the role and activities performed began to accrue as soon as the patient presented at destination hospital. The specific areas chosen for the pilot program was the orthopedic and trauma center and associated departments, including: Surgery, Imaging, X-ray, casting, lab, orthotics and prosthetics, medical supplies, physical therapy, etc., and the Spine Surgery Program. Once it was determined that the program showed feasibility and smooth internal operations, the project scope was scaled to include other health travel programs for expansion to other service lines, namely cancer and cardiovascular services. The Health Travel Coordinator’s Role Responsibility and Professional Qualifications The health travel coordinator qualifications and skills competencies require a working knowledge of anatomy, physiology, medical terminology, pharmacology, community support resources, and hospital policy. This will enable them to functionally review the care path designed by the referring hospital. These skills enable them to easily liaise with both the patient, the referring and consulting physicians, and both hospital systems care management teams to anticipate any challenges and arrange to overcome them prior to actual occurrence. Usually, this role is filled by a trained professional nurse or social worker. In most cases, the role exceeds the ability of a layperson acting as a medical tourism facilitator. It is not advised that this role be filled by an entry level worker who has yet to learn the operational and political nuances of a large, academic teaching and research facility. Roles and Responsibilities Prior to Arrival • To facilitate medical records and imaging transfers from referring physicians and imaging centers • To coordinate insurance authorizations, rate quotes and patient financial responsibility details
• To arrange for any language or cultural awareness preparations that may be required for the patient and/or family and guests Roles and Responsibilities upon arrival • To act as brand ambassador and welcome them as they arrive at the reception desk for their initial appointment • To coordinate physician telehealth conferences, researching any required answers or missing information required • To review and discuss with consulting specialists any concerns or questions that may arise from the care team or referring physicians. • To visit the patient and family during their inpatient stay, at least twice daily to address any questions or concerns. • To coordinate pre-discharge care team consultations with the hometown physician, and remain engaged with patients through the first 180-days post discharge Roles and Responsibilities upon Discharge • To provide assistance in locating support groups, if required during aftercare • To ensure that patients understand follow-up instructions • To arrange subsequent appointments and transportation and or directions to those appointments • To remain on call and available around-the-clock by mobile phone for patients/families, and care team members until they arrive safely back in their hometown • To serve as a support and “go-to” problem solver. In this capacity, the health travel coordinator connects patients to resources including, but not limited to social/mental services, pharmacy, clinical trials, or their hometown and destination physicians. Project Note: The project was completed on time and on target for a client budget of under $60,000 USD, inclusive of consultant travel costs and project specific software licenses. Your project costs may differ based on project scope, location, and time frame. To learn more about how your organization could benefit from a similar initiative, please connect with us today.
About Mercury Advisory Group Mercury Advisory Group is an international healthcare and health tourism management consulting firm that works collaboratively with clients to achieve and exceed their goals. Mercury serves as a change agent and provides practical guidance and industry expertise in • health and hospitality administration • regulatory health policy • business and market entry strategies • organizational development • facilities management • quality and safety accreditation • healthcare cost containment and sustainability • technology deployment • regulatory compliance • healthcare revenue cycle • insurance and employer contract negotiation • reimbursement strategy • healthcare leadership effectiveness, and • staff training and development Mercury’s 30-year heritage has produced a substantial portfolio of proven methods, deep operational insight and broad healthcare and health tourism management experience. This enables of team to quickly grasp the issues and develop workable solutions that can successfully and sustainably be deployed. Mercury’s clients span the globe in over 100 countries. Mercury Advisory Group is a wholly-owned subsidiary of The Mercury Healthcare Companies, headquartered in Denver, Colorado with offices on six continents. We help healthcare and health tourism providers to build trusted brands and to deliver exceptional high-touch patient experiences.
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