Case Study: Healthcare
From-scratch provider data stewardship earns wins in quality, compliance, and cost-containment
Health plan experiences immediate improvements in PDM and credentialing/recredentialing with Sagility
Sagility began with an in-depth analysis of the client’s credentialing and provider data management processes. The client had limited quality reporting, tracking, and workflows in place. Due to lack technology, the network was inflated 3x with disparate data.
Leveraging deep-domain network operations experience—across people, process, and technology—Sagility built a blueprint for PDM, credentialing, ongoing data validation and re-credentialing success. The plan started with workflows and reporting—then automation, with an eye toward automating credentialing, recredentialing, and provider verification. This end-to-end process rebuild was essential to fully optimize the client’s
network operations management.
A 10-member team launched the Provider Directory Validation process from Manila, Philippines and ensured that data is validated within 90 days.
To address the client’s key objective, Sagility leveraged our Provider Forward platform.
Provider Forward is a single-sign-on (SSO) platform which has a built in CRM for workflow management and is interfaced with third-party databases for quality and updated data.
Provider Forward helped in streamlining fragmented processes, inventory, and compliance tracking with visibility at the provider level from a contact center perspective. Today, the client has better control over data and through our analytics model, making process improvement decisions much easier.
From intake and assignments to tracking and monitoring, the client has experienced immediate improvements across PDM and credentialing/recredentialing. Automated workflows, outreaches and follow-ups are supported by standardized templates for auto email acknowledgements to providers. Additionally, Sagility manages audit samples (sampling method and size), audit templates and overall audit process along with quality score reporting along with trending, along with effective monitoring of aging and TAT of inventory. The client agreed to augment this services with provider data validation.
62%TAT improvement for Recred and 54% TAT improvement for Cred
99%Quality improvement for Recred and Cred
90%TAT improvement for PDM
99%Quality improvement for PDM
30% Credentialing and PDM, control over inventory and interactive dashboards
25%Increase in team size and future account growth