Now that ICD-10 has officially launched, the pressure is off, right? Some would actually argue that the real work is just beginning as ICD-10 presents a major business transformation event for all stakeholders.
For health plans, a successful ICD-10 transition strategy should include monitoring of key performance indicators (KPIs) as well as financial monitoring. Daily monitoring of operations will help you quickly identify and address problems, and determine needed remediation of benefit plans, medical policies, provider contracts and systems.
Hopefully, you collected your KPI metrics and baseline data prior to the October 1 go-live date. And your operations command center has already hit the ground running. But if you are a little behind or even uncertain as to your operational preparedness, it’s not too late to shore up your monitoring protocols.
Set your KPI metrics baselines. This should include a review of your staffing model, as well as working with functional area leads and subject matter experts (SMEs) to discuss employee productivity thresholds. Make sure you have the tools in place to help you measure service levels in each area.
Also, if you have 12 months of historical KPI metrics, you’ll have an easier time accounting for seasonal trends and establishing contingency plans should a KPI begin to show anomalies.
Monitor for success. Knowing what to monitor is determined by metrics that are influenced by drastic coding changes. Monitoring the organizational metrics likely to shift between pre- and post-implementation will also provide insight into ICD-10 coding impacts.
Maintain accountability. Your operations command center is a source of leadership and guidance to ensure that service and order is maintained after ICD-10 go-live. It should be capable of monitoring the environment, and use predefined procedures to react to any events. Staff your center with SMEs from functional areas from which KPIs are derived so they understand the variances and know the correct response.
Monitor cost neutrality. If you’ve conducted cost neutrality assessments or predictive analysis prior to going live, those outcomes can be combined with historical data as your baseline for on-going monitoring.
With appropriate post go-live monitoring, your organization’s transition from ICD-9 to ICD-10 will be smooth and successful. Learn more about the steps we’ve discussed here by downloading our white paper, “ICD-10 remediation: Post go-live activities.” For additional ICD-10 resources, visit the ICD-10 hub.
Terri Trimm, Senior Consultant, Optum Payer Consulting
Terri Trimm has 20 years of experience in the health care industry and a strong background in leading payer operations, technology implementations and process improvement. She brings clients a unique skill set with accomplishments in interpretation of regulatory standards, readiness assessments, compliance audits, developing, documenting and implementing corrective actions, cross-departmental team facilitation, improving member and provider satisfaction, quality improvement, business reporting, system upgrades and migrations. Terri specializes in project management, ICD-10, claims operations, HEDIS/CAHPs and HOS, NCQA accreditation preparation, physician credentialing and delegated credentialing.
Scottie Winslow, MHA, MBA Executive Director, Optum Payer Consulting
Scottie Winslow has 20 years of experience in the health care industry with 15 of those in health care consulting. She has also worked within provider organizations leading managed care related initiatives. As a consultant, she has experience in project management, revenue cycle management, ICD-10 assessments and remediation, business process improvement, technology implementation, and operational assessments. In her current role, she leads projects related to health plan operations, develops consulting service offerings, and manages client relationships.