Integration’s occurring in every facet of healthcare, but we’re focused on that which hits closest to home for you: Striving to integrate elements of credentialing and enrollment. There are practical steps you can take to start eliminating redundancies and capitalize on sharing information, regardless of what resources you have at hand and in spite of what you might perceive as an enormous task. After all, your title and level in the company won’t matter when approaching leadership with an idea to save resources and gain revenue faster by uniting forces or combining what steps are already in place.

The big-picture why: Every organization that delivers healthcare and employs or affiliates with providers is desperately seeking to reduce costs yet maintain or improve quality, just to survive. Scrutiny is banging at the door of the medical staff administrative functions now because some tasks you do are redundant with those occurring in enrollment or onboarding. Redundancy causes revenue loss. If you haven’t already connected the dots between PE and credentialing/privileging, take some time to research why healthcare leaders increasingly see synergy between those key functions, for efficiency and integration.

The ‘what’s in it for you’: See above! You’re being asked to do more with less, faster, for ever-more providers. Integration of functions isn’t about preparing the organization to replace you. It’s quite the opposite. You’ll be leading the effort to demonstrate how you (and/or team) fully comprehend the changes coming and are onboard to eliminate redundancies and share the fruits of your talent (skill in researching, parsing data, decision making, etc.). Any void you create in your day will quickly fill with other essential tasks—some you may not even have on your radar yet but will be a match for your skills and experiences as an MSP. Be a leader; show how you contribute to operational savings and increased revenue.

Discovery: Learn about processes and job descriptions tangential to yours. Where do they overlap? Use the following sample points to start inter- or intra-departmental discovery and discussions about eliminating redundancy and ultimately, achieving integration:

  • What departments or functions touch onboarding, credentialing, and enrollment at your organization: CVO, med staff, enrollment, billing, HR, etc.
  • Document the list of internal and external electronic means used to gather and manage provider info: vendor credentialing software, billing software, CAQH, PECOS, online integrated applications from a state or other source, a CVO’s/any other delegate’s software.
  • Is sharing a database or sharing screens an option in our current state?
  • Compare administrative tasks associated with onboarding, enrollment, credentialing—what items are duplicated?
  • At what stage of getting a provider onboarded and set up to see patients do these duplicate (or triplicate!) checks or actions occur?
  • Is there a reason for the double- or triple occurrences (i.e., will the data initially gathered change over the time from onboarding to privileging, rendering the update necessary)?
  • Could integration eliminate any of the following: duplicate background checks, reference checks, or interviews done cross-departmentally?
  • Would the integrated function:
    • Improve data transparency, accountability, and integrity? How?
    • Foster better communication between departments and team members? How?
    • Decrease time to enroll or credential? How?
    • Improve customer (read: provider) satisfaction rates? How?
    • Speed time to reimbursement? How?

Initial steps to integrate: Streamlining processes starts with eliminating redundancies and cross-referencing sources where the data you need already exists. Here are three logical places to start managing information and integrating:

  1. Compare the elements (data, application questions, supporting materials) needed for each function’s application(s). Then consolidate them into one.
  2. Establish a single practitioner database as the source of truth.
  3. Create the integration team or task force for the integration, ensuring representation from all departments or functions that touch onboarding, credentialing, and enrollment.