As the healthcare industry continues to undergo dynamic changes and rapid expansion, there is an immediate need to streamline processes and align data sources for optimal efficiency. Provider Network Management (PNM)_business practices and systems are outdated and inefficient, plagued by demanding back-office maintenance and low-quality data. The credentialing process historically has been especially challenging, lasting 90 to 120 days with rules and regulations that constantly change and may vary from state to state. The process of verifying a provider’s credentials lacks automation, requiring potentially 100s of primary and secondary sources to be checked manually. The need for improved and efficient processes is universal.
Historically, the approach to managing healthcare provider networks has depended on using multiple platforms and manual data verification to onboard a Provider. Continuing this approach today is outdated and highly inefficient. The need for automation and a virtual experience all within a consolidated system was a requirement d and remains a significant driver for change in the industry. The Salesforce platform provides a framework for this consolidated system, specifically within the Health Cloud platform.
The Attentis PNM solution focused on process improvement powered by Verifiable’s APIs and data along with Health Cloud to both automate and streamline the credentialing process. We identified that to fully address the issues facing credentialing, we would also need to improve the registration and recruiting processes.
The Credentialing process best represents the overall issues faced by a Provider Network Manager when dealing with inefficient processes. While the structure of the existing credentialing processes was valid, it relied heavily on manual data verification, which made validating a provider’s credentials inherently difficult. The process lacked automation relying on a credentialing specialist to search 100s of external sources to verify a provider’s credentials.
Our solution to streamline the Credentialing process was based on Salesforce Industries OmniStudio and Health Cloud. We implemented the following components of OmniStudio and Health Cloud as part of our solution:
Additionally, functionality within the solution included integrations with Verifiable, NPPES, and DocuSign. The data supported by Verifiable’s APIs allows for the automatic validation of credentialing data. The NPPES integration accesses the provider’s NPPES record to seamlessly pre-populate contact, education, and license information. The DocuSign integration allows the provider to sign their credentialing application electronically with ease.
The benefit of incorporating Verifiable is the ability to automate the process of validating a provider’s credentials, accurately and efficiently. Automated primary source verification can be done for a variety of records including, but not limited to, medical licenses, medical certifications, NPI lookup, state-controlled substance licenses, DEA registration, OFAC, as well as federal and state sanctions and exclusions. Integration with Verifiable is inherent to the process minimizing the need for additional configuration thus increasing efficiency.
Health Cloud offers numerous benefits including a provider database to create a centralized system of records, provider operations to seamlessly complete business processes, and network administration for managing and optimizing networks. Health Cloud is additive to the Salesforce platform, simplifying configuration and reducing implementation time.
Salesforce Industries OmniStudio provides many benefits which includes speed to delivery, declarative configuration (clicks not code), robust and supportable framework, scalability, and ease of administration/maintenance. OmniStudio, in conjunction with other Salesforce Industries offerings, is fully tested to seamlessly operate on the Salesforce platform for the annual periodic releases minimizing the risk of some critical applications/functionality failures as a result of a Salesforce version upgrade.
Another key benefit of our complete PNM solution is the ability to embed the programmatic enforcement of business and regulatory rules. OmniStudio can be configured to conditionally enforce logic to show/hide screens, sections of screens, fields, etc. based on certain parameters such as selections made in the UI by the end user driving what the user can do next. Decision support based on branching logic can also be implemented within OmniStudio to ensure that business processes and any non-standard use cases are fully accounted for.
Attentis Consulting is a registered Salesforce and Silver level Salesforce Industries(Vlocity) partner. Attentis has many successful Salesforce Industries implementations and focuses primarily on the Healthcare vertical with deep industry knowledge in the Payor, Provider, Pharmacy Benefits Management and Patient areas. We have industry professionals such as RN/NP’s, a PharmD and CMS/Medicare professionals on staff providing invaluable industry insight as well as playing a key role supporting our projects.
