Public Employees Health Plan (PEHP) engaged our team to assist with their ICD-10 financial risk assessment and ICD-10 transition plan. Watch the video to learn how we helped PEHP kick the project, set the strategy for their health care medical coding transition from ICD-9 to ICD-10, and position their company for improved efficiencies.
The Regence Group, Blue Cross Blue Shield - 5010 and ICD-10 Transition
Our firm was selected in a competitive RFP to review Regence transition plans to the new electronic data interchange standard that all HIPAA Covered Entities must move to by 2012. According to the Regence project manager, “As the Lead PM for a HIPAA 5010
project we worked with No World Borders. No World Borders was hired to perform an external evaluation
of our planning and designs for implementing the HIPAA 5010".
Results: On time, on budget. According to client, "Their
analysis was both comprehensive and deep. Many of the items they
highlighted were insightful and have proven to be accurate. No World Borders'
leadership of the team was critical to the smooth success speaking with
every level of the organization from the technical developers to the
I highly recommend No World Borders." - Project Manager, HIPAA 5010 project, Regence Group, Regence Blue Cross Blue Shield.
Health Care Provider - Business Medical and IT Impact of ICD-9 to ICD-10 Transition
A large multi-site health care provider with over 15 regional hospitals needed to assess the impact of the new medical coding standard icd10 and the steps to transition from ICD-9. In addition, the client requested advisory services to help set the strategy for initial compliance as well as to identify opportunities for process innovation. The company has several systems it needs to remediate, large staff training issues to
prioritize, and wanted to balance the provider perspective with that of the health plans it does business with. Revenue and reimbursement issues are also key.
Results: Our team was selected over competing firms because of the expertise we provide. We conducted business road map sessions, which helped align business and IT, and helped rapidly positioned the organization for change. A near term plan for compliance was identified with a step-by-step project plan and an identification of key roles and competencies. A review of existing business and IT artifacts helped identify gaps between the plan and what the client needed to achieve to comply with new mandates. Clarity around key business priorities and improved health care for patients are the expected long-term outcomes. Our team provided a planning framework as well as analytics to help the company prepare for the move from ICD-9 to ICD10.
Medicare Advantage Health Plan HEDIS 5-Star Rating System and Process Improvement
An innovative Medicare Advantage Health plan (later acquired by United Health) set an objective to improve its 5-Star Rating from 3.5 to 4.0.
Results: Our team facilitated a review of existing processes, created business road map sessions with key stakeholders and developed new processes to improve the CMS rating. New analytics, integration and other capabilities position the company for potential improved reimbursements in 2012 of over $5 million. Our team provided an analysis of the CMS proposed rule updating Medicare Advantage Plan payments.
Health Plan - Business and IT Impact, Implementation Plan for 5010 and ICD-10 Transition
A large health insurance firm with over 3 million lives under management needed to upgrade its claims system to comply with new HIPAA X12 5010 electronic data interchange standards. It was important that this effort lay the foundation for the ICD-10 compliance work ahead. Our team provided a review of the definition of the existing business process, IT requirements and legal compliance assumptions, and interviewed key stake holders. Key dependencies such as vendor HIPAA 5010 schedules and architecture were also reviewed.
Results: Our team identified a potentially severe compliance issue that the company was able to correct well ahead of the deadline. The second phase of the project was approved and work continued with a clear set of business processes defined, which has significantly reduced risk in the delivery of a new claims system. Our architectural review helped improved the development process, and improved alignment with business and IT added clarity around decision making.
Multi-site Hospital System - Value Base Purchasing and Revenue Cycle Management
An multi-site hospital system that had grown through acquisition wanted to change their perspectives on revenue cycle management from a fee for service based view to a view wherein CMS reimbursements were factored in to their planning. This required a review of their disparite revenue cycle and EMR vendors and systems, an analysis of current processes and a prioritization of processes that needed to be revised maximize favorable patient outcomes.
Results: Our team facilitated a review of existing processes, created business road map sessions with key stakeholders and developed new processes to improve the CMS rating. New analytics focused on quality measures and ICD-10 have positioned the medical system for improved ratings and patient outcomes, as well as an improved perspective on their CMS reimbursements prior to 2012.
Health Plan - CMS Reimbursements, Provider Contracting
A publicly traded firm sought to facilitate cross-functional initiatives that identified and improved revenue reimbursement from the federal Medicare program in a multi-billion dollar Medicare health plans division.
Results: Our team facilitated the process discussions with senior management and key stake holders, worked with senior management to implement them, and assisted in guiding negotiations for a new contract for managed relationships with an out sourced vendor improving millions in annual reimbursements.
Independent Practice Association - Electronic Health Records, Meaningful Use
Our team helped a well-known IPA transition to Electronic Health Records, including the planning, software selection, and training of the administrative staff, physicians, and other personnel.
Results: The client is positioned well for CMS inventive payments for Meaningful Use in 2011. The next step is to help the IPA prepare for changes to medical diagnosis and procedure codes with icd10.
Health Plan - HIPAA 5010 Transition, Architecture Review
A large health insurance firm with several million members was already planning a new architecture to support the move to the new EDI standard HIPAA 5010 and ICD-10. The Service Oriented Architecture team at the client had designed an elegant but complex infrastructure designed to speed the claims response time in a queue like system prior to being received by the core claims system.
Results: Our team performed an architecture review, which was delivered on time and under budget. We identified risks, and issues with the software development process. The final architectural review was presented to executive management and as a result the client elected to change course and opt for a lower risk architectural approach. The client acknowledged that we reduced risk and also called out issues with the current vendors who impacted the development schedule.
Community Health System - Electronic Health Records and Meaningful Use
A Federally Qualified Health Center (FQHC) multi-site health care provider with rural hospital and ambulatory centers needed to perform a requirements analysis, vendor selection and implementation of an Electronic Health Record (EHR) / Electronic Medical Record (EMR) system.
Results: Our team led the full life cycle project implementation, developed and maintained training courses, regarding software development practices and reporting methodology. A business road map workshop was part of the engagement, which helped align business, IT, medical management and other organizations to prioritize the work. Project was delivered on time and on budget.
Medicare Advantage Health Plan - Clinical Integration - Accountable Care Organization (ACO)
A Medicare Advantage health plan wanted to achieve a higher 5-Star Rating by improving the coordination and quality of care, patient experience, and to access higher CMS Quality Bonus Payment beginning in 2012. The client is targeting higher rankings and receiving higher CMS reimbursements via tighter integration with contracted health plans, and process improvements. Process improvement around Case Management and a partnership with providers in 2012 and beyond.
Our client is developing their strategy to launch an ACO and needed to develop processes for building a clinically integrated organization that also complies with Stark Law [Omnibus Budget Reconciliation Act of 1989 (OBRA 1989) and Omnibus Budget Reconciliation Act of 1993 (OBRA 1993)].
Second, the client wishes to ensure that the business, process and IT infrastructure is in place including case management and coordination of care systems and data, population management and analytics, and other key components.
Results: No World Borders Business Road map consulting helped kick off the effort and socialize a change in the culture. Since ACO and other initiatives such as ICD-10 combined with CMS financial incentives encourage a change from adversarial negotiations to a partnership, we focused on a win-win outcome for all trading partners and covered entities. To improve its star rating No World Borders first examined the client analytics (business intelligence) and dashboard reports with a desire to help inform management as to the process improvements required to achieve their goals. Second, we recommended process improvements based on the client identified areas for improvement including case management, disease management, prescription management, coordination of care, member / patient touch points with the call center, and provider / payor contracting. The client now believes they are better positioned for the work ahead to achieve higher ratings, which will in turn improve the quality of care and enable them to receive greater financial incentives. Third, we are working with the client on improved analytics via business intelligence, management dashboards, and improved population data management to continue the process improvement via their case management and disease management systems. The client is also looking to us to help them through the changes to their quality measures and reporting with ICD-10.
Additional note: The Accountable Care Organization is a physician-led entity – consisting of hospitals, primary care physicians, and specialists – responsible for managing the full continuum of care and accountable for the overall costs and quality of care for a defined population, that is partnered with their health plan. See our related blog entry regarding Achieving the Accountable Care Organization.
Top Ten Hospital - Clinical Systems Integration for Meaningful Use
A leading hospital recognized for innovation, quality of care and leading technology needed to develop a plan to integrate many siloed systems to improve the coordination of care and prepare to achieve Meaningful Use.
Results: We helped our client evaluate, select and implement enterprise application integration EAI software to integrate the clinical applications including Cerner, Meditech, Siemens, Quest, Epic, Eclipsys (Allscripts), etc. with the hospital’s Electronic Medical Record (EMR) using Health Level 7 (HL7) message formats and electronic data interchange (EDI). The project was delivered on time and met the requirements initially stated.
|Abbott Medical Optics - Medical Device and Pharmaceuticals
A life sciences company with revenue of over $1 billion needed a global product vigilance process & adverse event system deployed worldwide. The company is a global leader in the development, manufacturing, and marketing of ophthalmic surgical and contact lens care products. The company has direct sales operations in approximately 20 countries, and markets products in approximately 60 countries. Advanced Medical Optics chose a web-based system for its ease of use, the ability to configure the system to our workflow, zero-client architecture for quick deployment worldwide, ease of integration with ERP systems such as SAP, as well as, for its advanced query functionality. To make the project a success, our highly qualified solutions team consisting of information technology, quality, and regulatory / compliance experts, was selected to do the implementation.
Results: Abbott Medical Optics needed a product and a team that could identify, recommend, and implement the total turnkey solution. We provided the entire package from start to finish and delivered on-time, on-budget. No World Borders process transformation team helped implement the new compliance process, leveraging the human capital and process knowledge of the company and enabling it to be in full compliance with FDA guidelines.
|Workplace Management and Asset Management - Facilities Planning - Green, Clean Energy
Health Care Company - Lease Management
A large health care company needed to improve the ability to track leases and make better decisions based on the properties it owned. The client's outdated solution would not allow them to organize their assets based on entitlement, square footage, cost and geography in the most effective ways.
Results: Our team led an engagement to first clarify the client requirements. We then suggested a workplace management software system with data integration capabilities that avoided the need to re-key data. Finally reports were developed enabling the client to organize and report on the information and view dashboards of key performance metrics.
Sustainable Workplace Planning for Medical Device and Pharmaceuticals Enterprise
A large medical device and pharmaceutical company wanted to create more environmentally friendly buildings with improved sustainable energy planning. In addition, there was no single enterprise wide view of all assets and facilities budgeting. Workplace capital planning was also in disparate systems.
Results: We designed, developed, and implemented a
comprehensive total cost of ownership model enabling the client to track
life cycle costs for facilities-related activities across the
enterprise: real property / ease management, construction project
management, space management, call center operations, capital planning,
budget formulation, operations & maintenance, and environmental
sustainability. See more about our health care facilities sustainability exeprtise here.
| Leading Medical Device Firm - Health Care Reform Strategy
Our client needed assistance setting a new strategy that embraces key developments in health care reform such as the impact on medical device firms with respect to quality measures for hospital systems.
Results: Our team provided executive and key stakeholder education around quality measures that will go into effect in the next five years under the Centers for Medicare and Medicaid (CMS) mandates, and worked with the company to set a road map to develop and market its products in ways that support favorable patient outcomes and relevant messages to hospitals and ambulatory service centers.
Click here for more information on our medical device specific expertise and practice.
|Leading Retail Store Chain
A leading retail corporation with a well known consumer brand determined that it could improve customer service, reduce returns, and improve inventory cycles and holding costs by moving to a new Enterprise Resource Planning (ERP) system.
The new system required the documentation, modeling, evaluation, and prioritization of thousands of process across hundreds of stores before the new system requirements could be documented and implemented.
Results: Our Consulting team helped document the "as is" of the existing processes, enabling new system requirements to be built into the new ERP platform. We facilitated the development of new walkthroughs for the system, improving time to market, and most importantly business stakeholder approval and user acceptance. The system was deployed on time saving $millions for the client.
|Leading Real—Estate Technology / Financial Services Firm
Our client needed to complete an e-commerce ordering system that was extremely secure to service the needs of clients and a fiscal revenue goal within six months.
The system had to be designed, tested, and implemented in 6 months after a failed out sourcing initiative with another firm.
Results: Our team implemented the system on time in .NET, with new security compliance approaches now documented in Microsoft white papers.