Eligibility Management: Are you LEAN?

In two previous posts we discussed the changes in today’s un- and underinsured patients and the strong link between your revenue cycle and your patient care goals.

Today, we look into how most of healthcare quality programs are centered on clinical considerations, but it’s important to also focus on the business aspect of your organization. In this regard, quality assurance zeroes in on the finished output of processes with an emphasis on inspection and quality control, while quality improvement provides your staff with an opportunity to improve processes.

Yet a solid quality management program should go farther to include the appropriate application of analytics as a process control tool for monitoring, measuring and analyzing quality. By measuring and analyzing quantitatively and qualitatively, you can approach your eligibility management with a more holistic approach, where you’re better equipped to evaluate not only quality, but also the effectiveness of your quality systems and work processes.

There are multiple methods available for achieving quality improvement, including ISO-9000, Kaizen, Six Sigma, Lean, TQM and Business Process Reengineering. Let’s take a quick look at Lean, a methodology more and more providers have adopted with good results.

Lean is a quality improvement methodology originated decades ago by the Toyota Car Company and based on the revolutionary processes created by Henry Ford. It’s been used with great success in a host of manufacturing vertical markets. The book Doing More with Less: Lean Thinking and Patient Safety in Health Care, explains Lean this way:  

At its core, Lean thinking outlines a way to do more with less while coming closer to giving customers what they really want when they really want and need it and in the amount they need...…To meet customers’ specified value, a practitioner of Lean thinking identifies the value stream, a set of processes that produces the services determined by the customers. 

Any individual step within the value stream that contributes directly to the end value is considered a “value-added” step. Any step that does not lead directly to the end goal is considered a “non-value-added” step. Non-value-added steps are considered waste, and a key concept underlying the Lean thinking system is the elimination of waste.

In their article The Promise of Lean in Health Care, John S. Toussain, MD, and Leonard L. Berry, PhD, shared survey results from eight providers that had implemented Lean with impressive results: 

  • Percentage of on-time starts increased from a baseline of 50% to a mean of 70%
  • Operating room turnaround time decreased from a mean of 60 minutes to less than 40 minutes
  • Same-day surgery cancellations decreased from 7% to less than 3% of total cases

Of course, the examples above evaluate the effects of Lean with regard to clinical and administrative outcomes, which has been the history of quality measures in healthcare until recently. Today, quality as part of a healthcare eligibility management approach must go beyond the clinical and the administrative to include the business office with a focus on improved financial performance.


About Kent Smith

Kent Smith

Kent leads MediRevv’s new business sales initiatives and marketing and account management programs. He has built, from the ground up, a cohesive team of healthcare sales and marketing professionals who understand the critical aspects of any engagement: exceeding the expectations of and creating value for our clients; building enduring, mutually beneficial partnerships; and maintaining transparency and a high level of trust in our execution.

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