The Cost of Manual Workflows, and Where Automation Can Help

We cover new solutions promising to swap manual workflows for automated operations on a weekly basis, but it’s rare that we get a chance to devote a full deep dive to the motivations driving the innovation:

  • What workflows would see the biggest benefit from automation?
  • What areas are healthcare orgs hoping to evolve in their operations?
  • What teams stand to gain the most from automation? 

Medallion’s 2024 State of Payer Enrollment and Credentialing Report gave us that chance, shedding light on those answers through a survey of nearly 350 healthcare executives.

Among the key findings from the report was the fact that 45% of respondents say their staffing levels are “inappropriately low,” yet 34% also feel the need to further cut headcount expenses.

  • Those numbers are a recipe for burnout. 57% of enrollment and credentialing teams have experienced turnover in the past year, along with 36% of CNAs, 15% of NPs, and 11% of PAs.

One of the main reasons why enrollment and credentialing teams are feeling the pressure so acutely is because of the manual nature of their workflows.

  • The payor enrollment process involves wrangling information from providers to fill out applications, staying on top of the evolving requirements of various health plans, communicating the enrollment status of every provider, and constantly following up with payors by email or fax. 
  • Those slow turnaround times directly impact the bottom line, with 46% of respondents reporting that unoptimized enrollment workflows cause them to miss out on revenue.

That isn’t even half the battle, with the credentialing process taking just as long to gather provider data, check qualifications, and complete primary source verifications.

  • 84% of credentialing teams experience turnaround times of 15 days or more, which unfortunately isn’t too surprising considering that 30% manually verify credentials by visiting individual sites.
  • Every day wasted waiting on credentialing is a day the provider isn’t seeing patients, and that missed reimbursement turns out to cost an average of $10k each day.

If those problems hit a little too close to home, automation is more than likely going to play a major role in the solution. An end-to-end platform like Medallion might be the right way to make that happen, and you can check out our coverage of the platform for a complete overview of how it can help fully automate payor contracting and enrollment, credentialing, and licensing.

The Takeaway

It’s no easy task to balance operational costs with a mission to provide high-quality care, but with the US healthcare industry spending over $800B every year on administrative tasks, it’s time to find a way to thread that needle. For a closer look at these issues and how Medallion might be able to help, make sure to head over to the full report.

Medallion Sets Sights On Tackling Administrative Burden

Healthcare costs are climbing, burnout is at an all-time high, and new data arrives on a daily basis highlighting the heavy toll that administrative burdens are placing on the workers making care delivery possible. Each of those issues is wildly complex, which is why Medallion is setting out to automate away the cumbersome operational processes at the core of the complexity.

CMS’ just-released 2022 National Health Expenditures helps set the stage by wrapping some numbers around the size of these challenges:

  • US healthcare spending grew 4.1% last year to reach $4.5 trillion, outpacing the 3.2% increase seen in 2021. The two largest slices of that pie belong to hospital care (30% share) and physician services (20%), largely due to the massive amount of administrative and operational overhead that goes into care delivery.
  • That same administrative overhead is placing a huge weight on providers and operations teams, with CDC figures now showing that 46% of healthcare workers are struggling with burnout (up from 32% in 2018).

Medallion tackles this administrative burden with an end-to-end provider network management platform, which streamlines time consuming and repetitive tasks like credentialing, licensing, and payor contracting and enrollment.

  • The credentialing solution automatically performs primary source verifications, checks state licenses and board certifications, and provides alerts on provider eligibility changes to eliminate manual reviews and ensure regulatory compliance.
  • The licensing solution simplifies cross-state licensing and license renewals to help keep up with ever-evolving state requirements, as well as continuing education tracking in all 50 states.
  • The payor contracting and enrollment solution allows organizations to offload the payor negotiation process from start to finish, then solves the problem of getting providers in-network with enrollment services for any commercial and government payor.
  • All of that information is housed in a provider data management dashboard that serves as a centralized view of the provider network, improving oversight and slashing operations task time.

The Takeaway

The healthcare industry has its work cut out for it reigning in administrative costs and burnout, but platforms like Medallion help make sure that the work filling the plates of providers and digital health companies is actually advancing their mission instead of distracting from it. Make sure to schedule a demo here to check out Medallion in action.

DHW Q&A: More Care, Less Friction With Medallion

With Derek Lo
CEO, Medallion

In this Digital Health Wire Q&A, we sat down with Medallion CEO Derek Lo to discuss the emergence of virtual care and how to overcome the friction it brought with it.

Derek founded Medallion in 2020 to help healthcare companies automate credentialing, licensing, and compliance for their provider networks. He’s since helped scale Medallion into one of the largest provider network management companies in the US, with over 300 customers and $85M in funding.

Let’s kick things off with some background on Medallion. Can you share a little about the company and your platform?

First and foremost, Medallion exists to improve access for patients – to allow them to receive care where they want it and in the most cost effective way. Virtual care is here to stay, tons of studies are showing that both physicians and patients support it, but with that comes a whole new problem set.

A major component of that is licensing and making sure that telehealth providers can operate efficiently, but the second piece is insurance.

The multi-payor system in the US creates immense complexity, whether it’s claims and the entire revenue cycle industry, or more in our world: credentialing, enrollment, contracting, negotiation. All of these processes are wrapped around taking insurance as a provider.

That’s really what we’re trying to cut down on. We’re aiming to remove as many of these friction points as possible.

To fill in some more color on the platform, what are some of the ways that you remove this friction?

Like I mentioned, Medallion’s main goal is to automate away all of these operational and regulatory compliance tasks that companies have to do just to run their business. That starts with creating a system record for their provider data, so we’ve built our own CRM from the ground up.

What that’s allowed us to do is build different product lines on top of that, automations that tackle various operational pain points in those two main buckets of licensing and insurance.

On the licensing side, that includes things like getting new state licenses, maintaining and renewing licenses, continuing education tracking – all to help with network operations. On the insurance side, that’s where we’re removing friction by helping establish contracts with new payors, followed typically by enrollment, or in some cases, delegated credentialing.

There’s also a huge need for ongoing support with things like roster management, where provider groups have to share their rosters so everyone can track who’s in-network. That’s still a very manual process that a lot of companies are doing with spreadsheets, same goes for sanctions monitoring and compliance. That’s where we come in.

Looking at Medallion’s growth, it seems like plenty of companies share those pain points. How do you guide the direction of a company that’s growing so quickly?

I think a big part of leadership is finding a way to focus on the top one or two problems at any given moment, and being able to drill down on those problems that are right in front of you.

In one way, building a company is just a long sequence of decisions that plays out over many years. It’s the quality of those decisions, in aggregate, that ultimately decides how successful the company is.

There are obviously external factors – a great example being the SVB crisis – but even those are just another decision along the way. It’s our job to make sure that we get those decisions correct and back them with execution.

What’s a misconception that people have above provider management or credentialing?

At the end of the day, if you talk to any healthcare CEO, these functions are a cost center for their organization. They’re a strategic priority, but only because they’re a key gateway to revenue. Yet for that reason alone, people understand that they’re super important to get right.

We talk to companies all the time where things aren’t running optimally, so they’re worried about leaving revenue on the table because they aren’t getting credentialed fast enough, or claims are getting kicked back because enrollment wasn’t done correctly, and so forth.

It’s really important to tackle these problems, not only because of the missed revenue, but because solving them truly makes an impact in terms of growing efficiently, seeing more patients, and ultimately providing better care.

If Medallion had a secret sauce that you could share with other founders, what would that be?

I don’t think there’s necessarily a magic ingredient, but the biggest thing would have to be the execution component we were talking about earlier. That involves doing deep thinking on the market, and really focusing on the customer above all else

What does the customer need? What are their business problems? How are those problems being solved today? How could they be solved in an optimal scenario?

Every day we try to be as thoughtful as possible about how those answers align with what we’re doing and how we’re trying to serve those needs. We also have a fantastic team, so if we can keep focusing on what I just mentioned, in literally as many decisions as possible, then we’ll get a lot of decisions right in the long run. 

For more on Medallion, head over to their website or swing by booth #1831 at HIMSS.

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