Working with Care Coordination Institute, Virsys12 implemented their proprietary V12 Network application and the new MyHealth First Network (formerly MyHFN, now PHUN) ACO was operational for their initial population group in 90 days. The implementation also included deployment of Salesforce Sales Cloud, Salesforce Service Cloud, webform integration, and workflow automation, with custom solutions allowing MyHFN to automate complicated reports.

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V12 Network Enabled Process Improvements that Yielded Dramatic Results

Background

Prisma Health (PH) is a government-funded health system, based on the Greenville Health & Palmetto Health Systems. South Carolina’s largest healthcare network, it is comprised of two Accountable Care Organizations (ACO) – Prisma Health Upstate Network (PUHN, formerly MyHealth First Network, or MyHFN) and Prisma Health Midland Network (formerly Palmetto Health Quality Care, or PHQC). It serves more than 1.2 million patients annually and has more than 30,000 team members. Its objective is to improve the health of all South Carolinians through improved clinical quality, access to care and patient experience, while also addressing the rising cost of health care.

The Challenge

Care Coordination Institute (CCI) was formed to support the technology efforts required to run the Prisma Health ACO’s. Care Coordination Institute needed a core operational platform in place for the management of Prisma Health Upstate Network and Prisma Health Midlands Network. Staff within each ACO relied mostly on Microsoft Office products such as Excel, Access, paper-based processes and many home-grown systems to capture the physician network and demographic data necessary to operate and provide reporting. In preparation for Prisma Health Upstate Network, CCI searched for a centralized, comprehensive technology solution to administer reporting and handle the complexities inherent in operating a network of ACOs. Needs ranged from managing the physician network and tracking provider groups, contracts, member data, network communication, and support of all constituents. Providing a comprehensive and accurate provider directory was a key objective.

Prisma Health Upstate Network and Prisma Health Midland Network were designed to serve both Medicare and self-insured member populations and it needed to fully integrate with varying websites. CCI saw the ACO’s organizational restructuring as an opportunity to eliminate data silos and time-consuming processes. The pressure was on to find a technology platform that would not only meet these objectives but also provide the foundation for long-term operational stability and scalability while offering a dynamic solution for thousands of providers who would be relying on a fully functional ACO for coordinated, value-based care.

As CCI explored potential technology platforms for maximizing efficiency and data accuracy within provider networks, it hoped to find a model that could be replicated in other areas to provide the same cost saving benefits. Salesforce, with its robust capabilities and flexible, cloud-based products, was an early favorite. Virsys12, a Salesforce Gold Consulting Partner that specializes in healthcare, introduced V12 Network, their specialty application developed specifically for ACO’s, payers, and managed care organizations. From there the decision was clear for CCI.

The Solution

Working with CCI, Virsys12 implemented their proprietary V12 Network application and the new MyHealth First Network (formerly MyHFN, now PHUN) ACO was operational for their initial population group in 90 days. The implementation also included deployment of Salesforce Sales Cloud, Salesforce Service Cloud, webform integration, and workflow automation, with custom solutions allowing MyHFN to automate complicated reports.

The Results

Within the 90-day timeframe, the requirements were brought to life. Provider networks, contracts, fee schedules and more are managed in one system. The platform is now used for total ACO operational management as well as health system community/employer outreach for the state of South Carolina. Care coordinators use the system to track provider acquisition and onboarding and network case management. Integration with various websites allow for provider directory access and a one-of-a-kind provider community that immediately demonstrated ROI.

V12 Network enabled process improvements that resulted in dramatic reduction of administrative time, including a 75% reduction in time for provider directory updates, a 90% reduction to produce the provider directory, and a 70% improvement in accuracy of network demographic data, as well as a notable streamlining in the provider application process.

Furthermore, organizational agility and effectiveness has improved. Increased analytics and integration with diverse 3rd party groups in the network lends itself to data-driven decisions. Time needed to manage data for reporting has decreased—a significant benefit considering the amount of reporting required for CMS reimbursement. CCI also attributes the increased number of physician affiliations and contracts post launch to Virsys12’s successful implementation of the technology platform.

“The Virsys12 team brought tremendous industry experience and best practices specific to healthcare and the business of building an ACO network.” - John Supra, Vice President, Clinical Operations

Virsys12 and the V12 Network solution accelerated the decision making process…