The right technology and MSO help providers succeed
$400M in collections
28 Enterprise accounts
- Needed a nimble ambulatory solution for affiliate practices
- Lacked cost-effective alternatives to services from Epic and other vendors
- Unable to share and standardize data across Epic, Cerner, and other systems
- Limited visibility into real-time data made advising customers a challenge
- Fast implementation and onboarding allowed CaduceusHealth to keep pace with its customers’ growth
- athenahealth offered cost-effective options for organizations that were adding new practices
- Pre-built and customizable interfaces allow CaduceusHealth to gather and standardize data across systems
- Real-time visibility enables faster problem-spotting and analytics
For years, managed services organizations (MSOs) have provided practice management and administrative support to solo practitioners, medical groups, hospitals, and more. But recent regulatory changes are driving renewed interest in MSOs, which can provide the flexibility, efficiency, and cost savings that providers need to thrive. CaduceusHealth, based in New Jersey, is one such MSO. “I think MSOs play an extremely important role because we’re able to alleviate a lot of the technical, hands-on work from the providers and allow them to do what only they are qualified to do,” says Anna Mueller, senior enterprise account manager at CaduceusHealth.
But succeeding as an MSO comes with its own challenges. MSOs need technology that can be implemented quickly and at scale. They also need to be able to work across EHRs. The ability to standardize and share data across systems is critical, as is finding a partner that understands the MSO business model. For CaduceusHealth, that partner was athenahealth.
The right partner makes all the difference
CaduceusHealth’s President and CEO, Jim Bonomo points to three factors that made athenahealth the right partner: integration, data standardization, and transparency.
Many of CaduceusHealth’s customers use EHRs from Epic, Cerner, and other vendors. To serve these customers, CaduceusHealth staff use athenahealth’s built-in interfaces to share data between their customers and the athenaNet application, where they prefer to handle revenue cycle management work. These interfaces standardize data, making it easier to run analytics and pinpoint underperforming areas. Since all athenahealth customers are on the same network, CaduceusHealth can also locate the data it needs in the same place, no matter the customer. Standardized data also allows CaduceusHealth to develop analytics programs that can be used across organizations without any modifications, saving valuable time. As a result, Caduceus can quickly understand where its customers have leakage, or what’s contributing to an unusually high number of claim holds.
But the biggest factor in CaduceusHealth's decision was transparency. With athenahealth services, administrative staff, providers, and CaduceusHealth have complete transparency into billing activity, claim holds, and dozens of other metrics that make up overall financial performance. “Not once on athena have we ever had a doctor tell us they don’t have access to something they previously had access to, or tell us they used to be able to do something and can’t anymore. As soon as we put athena in place, they can see everything they need to see,” Bonomo says.
These capabilities and more allow CaduceusHealth to offer what Bonomo likes to describe as a menu of services that wrap around a customer’s existing IT services. For some customers, CaduceusHealth takes on the majority of the organization’s non-clinical work, allowing them to use their services as a fully outsourced solution. Other customers only need support with specific functions like onboarding or coding.
Improved transparency leads to stronger collections without adding staff
Before becoming a CaduceusHealth customer, Englewood Health outsourced its revenue cycle management to a firm running custom-built software on its own servers. Although that arrangement saved Englewood time and the expense of hiring a full-time billing staff, the group lacked real-time visibility into its own data. Instead, Englewood relied on month-end reports to get a sense of its performance. Without a billing office of its own, Englewood began the search for an MSO that could offer more transparency and found CaduceusHealth and athenahealth.
Once up and running on athenaNet, Englewood saw a 15-percent increase in same-store sales without having to hire any full-time billing staff. At the same time, the group improved its ability to track and collect patient pay responsibilities by making it easier to collect and post personal payment balances through a digital portal and a call center. As a result, personal balance payments went from being Englewood’s eighth-largest revenue source to its third-largest, behind only Medicare and Blue Cross.
Bonomo explains that the keys to Englewood’s success lie in CaduceusHealth’s ability to embed experts onsite and in athenahealth’s Billing Rules Engine. Eight experts from CaduceusHealth were onsite from the beginning, working hand-in-hand with staff to set up their new services. Once the group was live on athenaNet, the rules engine proactively scanned claims in order to catch errors before they could be submitted. CaduceusHealth staff were also able to create custom rules that filtered out certain claims they knew required more attention.
Fast implementation and onboarding accelerate a hospital’s growth
Today, South Nassau Communities Hospital is the Long Island flagship of the Mount Sinai Health System, boasting nearly 23,000 patient admissions annually. But 15 years ago, when it became a CaduceusHealth customer, South Nassau operated a single hospital with no affiliate practices. In the years between, South Nassau has followed what’s become a normal progression for CaduceusHealth customers of scaling up with support from CaduceusHealth and athenahealth at every step.
When the organization acquired its first practice, it discovered that its healthcare IT services, which worked well for a single hospital, didn’t scale well to affiliates. “Their vendor was not going to offer as flexible a system as they needed. And the operating cost to put that solution into a four-doctor community-based practice were going to be prohibitive,” Bonomo explains.
Instead, CaduceusHealth recommended moving to athenahealth’s EHR and revenue cycle management services, explaining that they could be deployed quickly, wouldn’t require additional investments in hardware, and could be easily managed remotely. South Nassau’s experience migrating that first affiliate practice to athenahealth was so successful, the organization decided to migrate all new affiliate practices onto athenaNet.
In particular, South Nassau was impressed with the short implementation time – practices were up and running on athenaNet in eight weeks on average – as well as CaduceusHealth's ability to embed experts onsite and manage the organization’s onboarding process. Having knowledgeable staff onsite helped South Nassau avoid the normal peaks and valleys that come with migrating to new services. CaduceusHealth also managed South Nassau’s onboarding process, which often poses a major challenge to growing physician networks. Since CaduceusHealth’s staff had built out South Nassau’s tablespace, they not only understood the services inside and out, but also understood their customers.
A partner for today and tomorrow
Caduceus and athenahealth began working together in 2012. Based on the positive results the two organizations saw together, Caduceus eventually decided to sunset its other technology services and partner with athenahealth exclusively. In addition to the technical benefits of its services, Bonomo points to athenahealth’s deep understanding of the challenges and opportunities of MSOs as a big factor in that decision. “athena has been a great partner. They really understand our business and they’ve been very flexible in the way that we’re allowed to work with our customers,” Bonomo explains.
* These results reflect the experience of one particular organization and are not necessarily what every athenahealth customer should expect.