Update to Original Blog Post | October 5, 2018: Since this article was written most, if not all, healthcare delivery organizations should have received fully executed contracts with all of the AHCCCS Complete Care payers. The time for rapid cycle updates and implementation is upon us. And while some of the reporting requirements and metrics are still, as yet, unknown we can still work the information that has been provided thus far.
Healthcare organizations should ensure there is a good level of collaboration and oversight when making these changes within their respective systems. A partially loaded fee schedule or some other similar error can cause hours upon hours of work to remediate the problems once they are identified. Proper planning, execution, validation, and reassessment is key to successfully navigating this new world of healthcare delivery in Arizona.
By: Dustin Miranda | October 2, 2018
Running a successful healthcare organization is 90% proper planning and 10% perfect execution.
If you fail to plan, you are planning to fail, as the saying goes.
Unfortunately, we are facing a quandary at the moment as Arizona’s RBHA changes to Arizona Health Care Cost Containment System (AHCCCS; pronounced like “access”) Complete Care Program.
Last year, it was decided that Arizona’s Regional Behavioral Health Authority (RBHA) would split into seven different health plans in order to give behavioral health providers and consumers more options when it comes to choosing their coverage.
While this plan certainly offers greater flexibility, it also means that behavioral health and integrated health providers must now adhere to seven sets of standards for reporting, quality metrics, codes, and reimbursement fees.
Like many of you, I have been waiting on the edge of my seat for the healthcare plan changes to come through – especially with the projected go-live date of October 1st, which – oh wait! – was yesterday.
Despite the fact that we may not yet have the full picture or the information we need to roll with these new changes as we would like, there are systematic steps you and your organization can take to prepare for the upcoming changes and handle the information gap as gracefully as possible.
Facing Circumstances Beyond Your Control
If you have been in the world of healthcare as long as I and my colleagues at John Lynch & Associates have, the delay in receiving the finalized health plan information comes as no surprise.
Whenever state-wide bureaucracy is involved, there are bound to be challenges, unforeseen circumstances, and red tape that must be crossed before projects can be finalized. Try as we might, sometimes those obstacles cause delays.
However, with proper planning and strategy, your healthcare organization can adapt to these obstacles and come out on the other side relatively unscathed.
The first step is to realize that this is out of your control. If the RBHA changes have not yet been announced, then there is nothing you can do about that – short of chasing down the powers that be and demanding answers.
What To Expect Next
The next step is to anticipate what is going to happen. Historically, whenever RBHA has missed a go-live deadline, they have either pushed back the go-live date or they have sent out the rules after the deadline but given healthcare providers a grace period to catch up. Since we did not hear of any deadline delays last week, it is safe to assume the scenario is what we will be dealing with.
The challenge with this scenario is that if healthcare providers receive the new guidelines later in the month but the changes are retroactively effective as of October 1st, then we will be humming along without a clue as to what we need to be reporting on for the first few weeks of October.
Until then, agencies that provide behavioral healthcare or integrated healthcare, or agencies that offer primary healthcare but plan to integrate in the next few years, do not know which reporting processes, timeframes, quality metrics, codes, and fee schedules to use.
Since it takes time to load new allowable rates and critical operation information into your system, a two-week delay in receiving the information may mean that your organization is unable to adhere to the new guidelines for a total of four weeks or more.
How to Get Ready for The Big Day
OK, we are all sufficiently scared now, right? Not to worry. This is where you can take back control.
There are three things that your healthcare organization can do to be as prepared as possible and make adhering to the new changes as seamless as possible once they do come through.
Form a Committee
The first thing your organization needs to do – if you have not already – is for a committee. Set up a meeting with all of your department heads and anyone who will be responsible for implementing some sort of change once the new guidelines come through.
Key members of this committee should include a clinician lead, such as your Chief Medical Officer or Clinical Director, the Director of Finance, the director of your billing and coding department, and a director of training who can disseminate critical information to all members of your organization from an education and training perspective.
This committee will be responsible for carrying out the next two steps for preparing for the big day.
Create a Rapid Response Plan
Once formed, your committee will be in charge of creating a rapid response plan that can go into action once the necessary information is made available. Many healthcare organizations struggle to take in new guidelines, implement the necessary changes, and execute on new directives in these sorts of time-sensitive scenarios.
However, by forming a thorough plan of action, you can prevent many missteps.
In order to adjust to the new guidelines quickly and ensure your organization is not missing large windows of reporting periods, your committee needs to form a rapid response plan that takes into account:
- who will be in charge of receiving the new guidelines
- what systems need to be updated first
- who needs to be informed or trained on the new codes and reimbursement schedules
- who will be responsible for testing and troubleshooting these systems once the changes have been made
Test, Test & Retest
The third step is to test any changes your organization has implemented. This is the part that many organizations either forget to do or remove from the action plan when they are trying to save time and cut corners.
However, testing, control, and stability procedures cannot be neglected if you are going to succeed in adapting to the new healthcare plan changes. If this phase is ignored, you will likely end up dealing with an even bigger issue a few weeks or months down the road when you realize your billing records and reimbursements are not making sense.
With this three-pronged approach, your organization will be prepared to handle the new RBHA changes as soon as they are delivered. To recap:
- Form a committee that takes in, processes, and disseminates the information as it becomes available.
- Form a rapid response strategy or plan
- As part of that plan, have a testing or control and stability phase after all of the new information has been added to your systems.
If you need help forming a rapid response strategy and organizing your departments during this challenging time, let us know. We are happy to help you find a plan that works for you and ensures you and your teams do not miss a beat.