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Amanda DiTrolio

HTN | Community Brain Trust | 6/6

June 6, 2023
Community Brain Trust

👋 Welcome to this week’s edition of 🧠HTN Community Brain Trust🧠 – a community-only email, sent to your inbox every Tuesday, surfacing the top insights and conversations from our community.

Note: We’re testing changing the formatting of the Community Update this week. Let us know what you think of the changes at the bottom of the newsletter!

🧵TOP THREADS OF THE WEEK:

In case you missed them, here are highlights of a few interesting conversations from different channels:

Threads included below:

  1. Phone number validation tools
  2. RCM manager customer discovery
  3. EMR API explainer
  4. Target market for Dual Eligible Special Needs Plans
  5. Measuring productivity for behavioral health care teams

1. Phone number validation tools


Q: Do folks have any recommendations for tools that validate phone and address information? Essentially is a phone a working number.
– Dhruv Vasishtha | via #buildersask



Abby Morss: We are looking at Experian's address and phone number verification APIs right now, so any feedback about Experian would be helpful too


Thiv Paramsothy: i think my past companies have used textmagic or Experian


Stuart Blitz: What about addresses? I assume some USPS API?

Judhajit De: I believe phonevalidator checks mobile or landline or fake. Not sure how good it is. There is a more expensive paid company. I am trying to look up the name. If you have an automated outreach vendor they usually have a service

Abby Morss: We try not to automate the actual outreach (people respond to us better when its a person on the line!) so if there was something that did ONLY validation, that would actually be preferable

Judhajit De: Got it! Let me look it up and get back to youOk try Neustar...Also check out CSG.

Manas Kaushik: My 2 cents:  the phone validation would be specific by payor type (aka socio-economic demographics) so it might not be one thing and something you should check with the vendor on...

Samir Unni: more generally, it'd be great to have a map of demographic segments → preferred contact method(s) → contact info brokers / validation vendors. It's unnecessarily opaque at the moment.

Abby Morss: I think ^ this would be amazing. Honestly it can be hard for us to know what vendors will be good until we start experimenting ourselves because we work with a Medicaid population and a medicaid/ medicare cohort that is 65+

Michael Stratton: Smarty Streets is great w/ address validation. but the larger question is what “good” looks like to you for validation - do you just want to validate the address is real or do you want to validate the person is actually at the address? Most vendors will only provider the former.There are some similar APIs for phone numbers, they’ll tell you if the number is real or not, what type of line it is, who the carrier is, etc… but won’t necessarily tell you who owns the number.Smarty Streets is good at informing you if the address is valid from a mail perspective. I believe there is a USPS API that does the same thing but it’s a lot harder to use.

Daniel Goldberg: For phone numbers - Twilio Lookup is extremely simple, and can be tested without code from their console. I’d start there by quickly testing out some numbers known to be live / defunct. Perhaps the current functionality (which will tell you carrier information & caller name) is enough, especially if compared to internal name data? They also seem to have some pilots to get you more authoritative identity data & connectivity status

Eric Jain: Twilio + Smarty are great for checking if a phone number or street address exist (i.e. catching typos). If you need to verify someone's identity (i.e. for detecting fraud), you'd use a service like Onfido, Experian, or Neustar.

Manas Kaushik: I am sharing some interesting work. This paper found and used 6 indicators of homelessness [link here]The homeless address indicators were based on six sources: (1) a comprehensive directory of shelter and single‐site supportive housing programs provided by housing program staff from Hennepin and Ramsey Counties in response to an open‐ended inquiry by electronic mail. We added several other address types noted by local homeless experts to this directory, including (2) the General Delivery Address (GDA)— a free service offered by the U.S. Postal Service for an individual's mail to be held at the post office; (3) addresses of local homeless service centers collecting mail for homeless clients; (4) free text responses (e.g., “homeless”) recorded in the mailing address section of Medicaid enrollment records synonymous with homelessness; and (5) addresses of institutions commonly used by homeless individuals, including hotels, places of worship, and hospitals (Zech et al. 2015). Finally, (6) within the data, we observed frequent use of the addresses of county administrative offices and added these locations to the directory.

2. RCM manager customer discovery

Q: How do you get customer discovery calls for backend employees at hospitals (RCM managers specifically)?

Cold LinkedIn and email has almost no conversion rate. Would try cold calling but there are not much phone numbers out there.

From the discovery meetings I do book the amount that connects me to other people is fairly low as well.
I make it very clear that it's purely research and not a sales call, but doesn't seem to help.

– Anonymous Bot | via #buildersask

Mac Bolak: I would see if you have any success with expert marketplaces like Tegus. Cold calling, I'm guessing there are thousands of numbers available. I'd suggest using an auto-dialer like Connect and Sell and running through the phone numbers which you could get from somewhere like Lusha. If those two don't work, I'd suggest going to an industry conference. I would focus on those two channels

Mark Liber: Go to one and ask in person

Nick Neral: It sounds like you’re not providing any value or incentive for them to want to pass you on. Most people with read straight through you’re just trying to do research. Health systems are very difficult to crack into and often very relationship based selling. I admit cold calling can be a big waste of time into hospitals between switchboards and gatekeepers, but most other mediums can have decent success rates with good messaging.

Yansen Zhou: Have loved User interviews for these types of individual contributor interviews (actually used their service to do a batch of 10-15 RCM/medical biller interviews sometime last yr). Anyone more senior, and you’re gonna need to get an intro and you’re use your network (or pay for it on a Tegus or something of the like)

Drew Howard: +1 on Tegus. Super helpful or I've also had a lot of success on Upwork finding these types of folks

3. EMR API explainer

Q: Sorry for asking this question if it has been answered before. Can someone explain the different API solutions for pushing new patient data and updating the patient record on EMRs that have a record of that patient?

Can Particle’s Bi Direction update handle it?

Ali Omrani | via #buildersask

Brendan Keeler: For an application that's been sold to a hospital? Or a standalone provider organization? Or a PHR?

Ali Omrani: No, the use case is for updating the EMRs of another third-party online clinics for payment purposes. Let’s say company A provides a triage/remote monitoring service for a company B which is a telemedicine company that uses Athenahealth AND company B wants to bill the insurance and need the record of notes and data collected by company A.

Brendan Keeler: Okay, you're essentially a business associate. So scenario 1So no, particle uses health information networks for querying data but you can't drive billing off of data exchange. for workflow driven back and forth exchange, you need to do a direct integration. [Linked article here].

Ali Omrani: So are there any on-ramp services that support basic bidirectional exchange for health notes and 4-5 standard questionnaire results?

Brendan Keeler: All the ones listed in the article above. You will need to do point to point exchange. You can use a vendor like redox or Healthjump or nexhealth to help. You will need to do point to point exchange. You can use a vendor like redox or Healthjump or nexhealth to help.

Ali Omrani: I see so without an endpoint you can push to everyone but there is no guarantee that they accept it.

Brendan Keeler: You need to do a direct integration to really achieve the workflow you described. The article above is a good one to open (and possibly read), as it lists them categorically and directly pertains to all content of this thread

Anthony Leon: Brendan (as always) hit it on the head. I'll add, the network on-boarders talk about bi-directional but it is slightly misleading in the traditional sense. There are alternatives to Redox and HJ for direct integration type of projects which include managed services (most engine orgs and there are service groups that are trained in those engines).However, HJ has done a good job of creating/mapping what's available to them across many diff EHRs (especially ambulatory). Redox can be a good solution depending site/use case. I believe they've ramped up their services more recently to be more competitive against the engines as well.

Ali Omrani: @Brendan Keeler & @Anthony Leon Can you also elaborate about sending a report as PDF? The use case is for results the records that are not part of standard EMR records like AI generated metrics. Can you rely on the messaging feature?

Brendan Keeler: Sending a report as a PDF is a very common mechanism to get atypical data into the EHR. You need to align on document type but otherwise the most straightforward write operation you can doThat being said, your AI generated metrics can generally be filed into flowsheets or similar concepts. Just take a little more work with the health system to map appropriately

4. Target market for Dual Eligible Special Needs Plans

Q: Good morning. Has anyone focused on D-SNPS for a target market? If so, can you help me determine whether the CMO is the best initial touchpoint for a tech platform focused on integrating the patient, family, and informal care team into the care plan? Thanks for any guidance.

– Stephen Farber | via #buildersask

Duncan Reece: is it a tool that the plan uses?  or a benefit that is provided by the plan to the member?  or is it a "provider" solution?

Stephen Farber: D-SNPs  (Dual Eligible Special Needs Plans) are Medicare Advantage plans which offer specialized care and services for dual-eligible beneficiaries ( those qualifying under both Medicare and Medicaid). There are other SNPs as well — I-SNP focused on those within an institutional setting, and C-SNPs focused on specialized chronic conditions. We enable a assignable digital care plans, provide resources (e.g. SDOH directory, resources which the payer/provider want to promote, etc.) to the insured plus their formal and informal care team, include educational materials, allow sharing and communication within the broad circle of participants, etc. and provide information back to the providers (and payer) about the insured’s activity outside of the clinical visit. Bottom line for the plan — improve satisfaction, increase efficiency, fill the actional data gaps, and ultimately improve and reduce the total cost of care

Manas Kaushik: Stephen

  • Care plans are relevant more for the Health Plan than provider because payors are legally bound to have care plans but  providers (unless delegated for Care management) are not legally bound to have a care plan.
  • My guess is that your key client at DSNP would be VP or SVP of Care Management
  • Often CMO's don't oversee Care Management function (which indicates something about CMO role and Care Management function at Health plan)

Stephen Farber: @Manas Kaushik Thank you for that insight about the CMO. What a strange structure. I had assumed that Care Management would be my second stop. The benefit of engaged members on HTN continues!

5. Measuring productivity for behavioral health care teams


Q: How do others with W2 care teams think about care team productivity and incentives? What targets do you set around productivity or utilization (e.g. # of appointments per day), and do you do anything to reward higher caseloads and/or quality? Particularly interested in behavioral health care settings. (also posting to #buildersask.)
– Anonymous Bot | via #topic-behavioral-health and #buildersask


Arpan Parikh, MD MBA: As a hot take, I’m personally not a fan of tracking appointments per day or even caseload (total number of unique patients seen over a given period of time) as metrics for productivity.



If choosing a single metric, I think schedule utilization (eg the number of kept appointment hours divided by the number of total available clinical hours, with a theoretical maximum of 100% and the potential to sometimes exceed 100%) on a weekly basis is the highest fidelity metric. Of course appointments and caseload can be useful adjunctive pieces of information alongside schedule utilization.

Sarah Verducci: Here are some thoughts at top of mind about behavioral health you often see (weekly):

  • Available hours
  • Client contact hours
  • Late cancel/no shows as different piece of the pie

Different populations have different rates of coming to appointments, so if you have a Medicaid population, you would anticipate a higher late cancel/no show rate

For example:

  • 32 Available hours
  • 25 Expected client contact hours

Other considerations:

  • Some type of outcomes-based pay (based on retention, clinical outcomes, etc.)
  • Ratio of time available for evening and weekend appointments
  • Higher pay for areas where there are shortages

Millard Brown: I think expected F2F hours should be in the 5-6 hrs per FT day. For a given week, it depends on how many other things you ask of providers. Documenting intakes is also much more extensive than documenting f/u appts - so the mix of those matters too. I would be careful about measuring throughput or unique patients without also tracking outcomes to ensure misaligned incentives do not occur.

Kevin Stephens Jr, MD MBA: I've had some experience with this, but more so for incentives. Essentially, I'd first decide what the goal is and then think about the following factors:

  1. Team-based versus individual (both have pros/cons)
  2. Performance versus productivity (i.e., bonusing for things that affect the bottom line versus things in control of the employee)
  3. Achievability (i.e. is this for those who do enough or to truly reward those who go above and beyond)
  4. Process versus outcomes (usually I've used a little of both)

David Eisenberg MD, MMCi: When I did this, it was at an FQHC in an underserved setting and I looked at a few things:

  • new patient case load v existing. If someone had been around >3 years with largely the same panel their no show rates usually hovered 10-15%. If someone was a long standing employee with a long standing panel and poor show rates, look at other resources their patient may need etc, lastly I would discuss with the clinician
  • Compare tele v in person is important as well
  • These metrics first and foremost can help a company understand how rapidly to grow their department
  • Also eval patient engagement with their physician to ensure effective collaboration between therapists and docs
  • We did not actually set metrics incentives, since then it can encourage people to take on more commercial patients than anything who might  have higher show rates. However, those who did seem to be able to keep case loads across all payer setting were looked at first for leadership roles

❓UNANSWERED ASK:

Here we highlight a question from the Slack that needs some additional community insights - if you have a helpful thought, jump in below!

Q: I'm looking to describe the different ways for an agent to support a member - including screen sharing and co-browsing. Does anyone have a good run through of the various options and differences? I'd like to share some well defined options with the team. Examples:
  • Screen sharing allows an agent to see what a member sees, but no ability for the agent to control the experience or highlight certain areas.
  • Co-browsing would allow an agent to take control of the member's experience and show them how to use a product).  Are there other examples I'm missing?

– Andrew Rosenthal | via #topic-product

Jump in with some insights here!

🤖HTN KNOWLEDGE BOT:

If you have your own question(s) to ask, don’t forget that a good place to start is our HTN Knowledge Bot. It’s our smart search tool that makes it easier to access the wisdom shared within HTN powered by ChatGPT. You can log in and use it on the website (here) or see how to use it directly in Slack here. Check out the example ask below!

✨HIDDEN GEMS:

Here we highlight helpful resources from across the community:

  1. Ambulatory Surgery Center Market Map Database via David Paul
  2. Integration avenues: How to pick a route that’s best for you via Sarah Bottjen
  3. What's the future of guidelines? via David Van Sickle