Menu
VillageCareMAX, the managed care plan of VillageCare, operates in New York, Bronx, Kings, Queens, Richmond, Westchester, and Nassau counties. It serves dual eligible and Medicaid beneficiaries 21 and older through three plans for individuals with long-term care needs:
In 2024, VillageCareMAX added a Medicare Advantage Prescription Drug Plan (MAPD) that serves individuals who quality for Low-Income Subsidy. VillageCareMAX’s 25,000+ members are quite diverse; 2 in 3 members’ first language is not English. As with most managed long-term care plans, members have multiple chronic illnesses, multiple functional deficits requiring assistance with daily living tasks, and high incidence of cognitive impairment.
In addition to VillageCareMAX, the organization offers home and community-based services, including an assisted living facility. VillageCare’s network delivers the right service at the right time and place.
VillageCareMAX faced the challenge of managing 54,000 providers without a single, unified platform. Prior to implementing a solution, their provider team relied on disparate Excel spreadsheets and manual reconciliation – a laborious and disorganized process – to manage their provider data. This method proved inefficient, creating a significant challenge in organizing and accessing a large volume of provider information. Without a centralized system, maintaining accurate data, tracking changes, and ensuring efficient communication became complex and time-consuming.
Historically, VillageCareMAX’s team was tasked with producing a precise and up-to-date report encompassing all active providers and their respective rates. This involved sifting through multiple Excel files, cross-referencing data with the claims system, consulting with account managers, and coordinating with credentialing teams. This exhaustive process aimed to guarantee the delivery of an accurate report to the Finance and leadership teams. However, the reliance on manual efforts not only proved highly inefficient for the team but also introduced the potential for human error, highlighting the need for a more streamlined and error-resistant approach.
As their membership grew, ensuring accessible, comprehensive, accurate, consistent, and valid provider and network data became increasingly challenging. Their network management team decided to implement Salesforce in order to consolidate provider data into a singular, centralized platform. This shift marked a departure from the myriad spreadsheets and manual processes that had been the conventional means of managing data, signifying a proactive step toward enhanced efficiency and cohesion in their approach to network management.
VillageCareMAX successfully addressed the challenge of managing 54,000 providers by implementing V12 Network, built on Salesforce, as their centralized network management platform. This implementation involved a seamless migration of historical data, including contracts, fee schedules, and provider demographics, from Excel to Salesforce. The integration process leveraged the capabilities of CAQH and Outlook.
With V12 Network, VillageCareMAX now has a centralized database and source of truth. The VillageCareMAX team has retired the cumbersome practice of managing countless Excel files by consolidating and migrating the data into V12 Network. The provider team now solely relies on V12 Network for uploading comprehensive fee schedule rates and contract details. Notably, they can effortlessly generate the Fee Schedule Report directly from Tableau and provide the report to the requestor instead of first manually checking various Excel files to ensure they are sending the latest data.
Looking towards the future, VillageCareMAX has set its sights on further enhancing data accuracy by incorporating additional sources such as the NPPES directory and publicly available data into their system. They also plan to digitize and streamline the provider onboarding process by integrating Experience Cloud into their platform.
Through the partnership with Virsys12, VillageCareMAX gained a comprehensive understanding of the power of the Salesforce Health Cloud platform. Virsys12 also played a crucial role in documenting the processes associated with each team member’s role, enabling effective training for new team members, and supporting VillageCareMAX’s ongoing expansion efforts.
Collaborating with Virsys12’s certified team of Salesforce experts proved instrumental for VillageCareMAX, enabling the automation of workflows that were once laboriously managed manually. The provider team, which previously undertook a significant portion of tasks manually, experienced a transformative shift with the implementation of an automated system, revolutionizing their day-to-day work life.
The introduction of V12 Network also heightened operational efficiencies for VillageCareMAX. This strategic move allowed them to centralize and refine their data, ensuring that members could consistently access accurate and up-to-date provider listings. Customization and automation emerged as pivotal elements in VillageCareMAX’s success, empowering the provider team to seamlessly run reports, generate amendments, verify rates, and update provider data. Given the constant evolution of this information, standardization became essential, while the capability to report on non-standard remained equally crucial.
According to Melissa Leudmann, Senior Network Management Account Manager at VillageCareMAX, “With Virsys12, our provider data management and reporting process is far more efficient than it used to be. Now we can generate a current report from our source of truth and provide it to the Finance team without the need for extensive file comparisons and checks.”
VillageCareMAX successfully addressed the challenge of managing 54,000 providers by implementing V12 Network, built on Salesforce, as their centralized network management platform.
With V12 Network, VillageCareMAX now has a centralized database and source of truth.
“Before working with Virsys12, it was nearly impossible for our provider team to run analytics due to the manual processes that were required. Now, we are able to run reports effortlessly and we can rely on a single source of truth with V12 Network.”
-Ku’uipo Fales
AVP, Data Management, VillageCareMAX
Virsys12 empowers healthcare organizations with the technology needed to eliminate inefficiencies in provider data management and workflow processes. Through customized applications that simplify provider network and lifecycle management, our solutions address a variety of use cases, including provider onboarding, credentialing, contracting, network operations, and data management. Our leading SAAS products, V12 Network and V12 Provider Data Engine (PDE), help streamline processes, improve communication, and ensure accurate and up-to-date information about healthcare providers within a network.
If you would like to learn more about V12 Network, V12 PDE, and our services, send us a message! We would love to hear from you.
Ready to transform your business? We can help.
How can we support your goals?
