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Carelon partners with health insurers and healthcare Providers to expertly manage cost effective services; providing value to both insurers and Providers, specific to home-based services such as Home Health, DME, and IV Infusion based on a shared risk model. Carelon’s vision is to use technology to automate human driven processes, measure performance, and provide value to their partners. Carelon engaged Virsys12 to implement V12 Network, an application acting as an operational hub sitting on Salesforce’s Service Cloud, which now provides connectivity for the highly complex many-to-many relationships necessary to manage the contracting and credentialing processes for Providers and Provider groups, workflows and automations to increase productivity, along with activity tracking to expedite efficiency and growth. Initial metrics reflect decreased manual processes from 46-99% across tasks. Additional integrations with data for provider credentialing and online provider look up by geo on company website added in 2018.
Carelon is a healthcare services company dedicated to delivering whole-person care with connected healthcare solutions for better outcomes and experiences. Headquartered in Indianapolis, Indiana, Carelon is focused on improving outcomes, making better care more affordable, and reducing complexity of accessing care. They have blended their companies’ 150 years of combined experience, powerful capabilities, unmatched data, flexible solutions, and collaborative partnerships with a single goal in mind — to make it easier to deliver whole-person health.
Looking to grow and improve efficiencies, Carelon began looking at scalable technology for managing their provider network. Growing over 500% in members serviced from 2016 to 2017, it was vital to implement a technology which would improve efficiencies in provider network management, credentialing and contract management, and access to provider information to adequately assist Carelon in offering members the quality care needed for optimal outcomes.
“We were managing and communicating Provider contracting stages, credentialing, and service issues on spreadsheets, according to Staff Vice President, Michael Dant. “We were using disparate CRM tools, we were experiencing a huge drain on performance from data entry and manipulation, we had no productivity measurements in place, disconnected workflows, inconsistent data entry, and we were using cumbersome ways to track network development, a core need for our continued growth”.
Word of Virsys12’s growth and success in the healthcare arena prompted Carelon to contact the technology consultancy firm in the fall of 2017. “Virsys12’s extensive experience with Provider network management allowed them to assess needs quickly and their V12 Network application was recommended to help Carelon achieve data tracking, reporting and growth goals,” Dant comments, “The Virsys12 team instantly understood, not only our business model, but the challenges that come with managing vast Provider networks; tracking activities, managing contracts, Provider credentialing, and data reporting.”
Acting as an operational hub sitting on Salesforce’s Service Cloud, the customized V12 Network now provides workflows and automations within highly complex many-to-many relationships necessary to track the contracting and credentialing processes for Providers and Provider groups. Near real-time data is brought in via an API to keep Provider directories and contracts up to date and accurate. Management maintains a constant view of each Provider network, along with any specific requirements for each state, Provider contract terms, fee schedules by location and by payer, along with other provider demographics. Managers can monitor Provider interactions and activities throughout the contracted care cycle.
Six weeks after Carelon went live with a customized V12 Network implementation, metrics tracked by the firm revealed strong leading indicators of future operations improvement including 99% reduction in provider data entry time, and 46% reduction in account data entry based on workflows and automations. The API with V12 Network allows inter-departmental data sharing, a process previously requiring over two hours per transfer, and now estimated to save 99 days of work time per year. Prior to implementation of V12 Network, tracking data metrics towards goals was non-existent, now provider entry, calls, texts, visits, and other interactions are all measured and available on-demand for management decision making.
“From day one Virsys12 was thoughtful, creative and accommodating. It is a very collaborative partnership,” summarizes Dant.
The initial engagement with Virsys12 has continued to grow as Carelon expands to more states and adds more services for a growing roster of Payer and Provider partners. After the initial launch, a clone function was developed to allow an account to be completely duplicated in the system necessitating only minimal updates per location. This addition offered an average savings of 15 minutes per account. More innovative technology solutions are on the Carelon horizon including more departments using the V12 Network along with linking the Carelon system to Provider portals with an increased focus on the Provider directory. In 2018, Carelon continued expanding to additional networks and added Provider look-up by geo and specialty. Our work continues.
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