LA Care

Elevating healthcare through digital transformation to build stronger, vibrant and healthier communities

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We partnered with LA Care to achieve 50 per cent higher operational efficiency through mobile adoption

Overview: 

LA Care Health is the USA’s largest public health insurance entity with close to USD 12B annual spend. As a digital transformation partner, we built a complete digital platform for their provider facility and certification needs and realized over 50 per cent higher operational efficiency across their business functions. Through an online/offline mobile tablet-based app, we automated the result analysis for corrective actions, search for providers, schedule reviews, and manage daily activity through a resilient AWS cloud platform, and view real-time notifications. 

The challenge: 

Poor quality provider data lead to high operational costs and poor standards of service that was delivered to members. Being in the healthcare delivery space, this could not only cost the company financially but also damage their reputation and credibility. 

As a result of inaccurate and incomplete provider data, the LA Care Health Plan could not deliver on the following five basic functions – 

  • Member assignments: Assign new members and reassign current members to primary care physicians (PCPs)
  • Healthcare delivery: Ensure members are able to receive care from various hospitals, practitioners and ancillary provider types based on regulatory parameters through complete visibility of the provider network and their associations.
  • Compliance & Regulation: Submit provider network adequacy and other provider-related data to regulatory and accreditation agencies to ensure LAC is compliant.
  • Certifications: Certify providers (18+ certifications) with a streamlined credentialing workflow.
  • Reviews: Conduct manually intensive facility site reviews for various provider facilities on different periodic schedules with active tracking of review assignment, corrective action plans (CAP), scores and status.

The Digital TaaS advantage:

Our approach involved the creation of an effective channel for receiving provider data from authorized sources mandated by their engagement model with LA Care.

Icons: 

  • 360 Degree visibility: Automation of attested provider data and their relationships with IPAs, Hospitals and ancillaries, in line with data quality regulations, credentialing, FSR and contracting
  • Workflow models: Standardisation of provider profiles, with certified records in the master data repository, representing provider credentials and FSRs (facility site reviews)
  • Holistic dashboard: Provider facility review dashboard with visibility into the past, current and upcoming reviews, driving timely review processes
  • Digital mobile platform: A mobile platform that allowed nurse practitioners to capture facility reviews, PARs and medical records data which integrated with MDM, on-the-go

Outcomes:

Our solution enhanced their provider management UX creating a multi-dimensional, cross-functional view for business units on provider relationships, credentialing and intake workflows. This implementation resulted in accurate member assignments to verified, certified and validated providers in the network creating a seamless member experience.

  • Enhanced provider management and tracking accuracy from 65% to over 90%. 
  • Reduced turnaround time for provider changes by 70% with real-time updates.
  • Facility Site Reviews (FSR) digital mobile platform leading to 50% operational efficiencies across RN roles.
  • Automated credentialing workflows connecting to external sources for certification validations resulting in 90% scenarios as pass-through (no touch)

Timely and accurate provider network adequacy reporting to regulatory bodies and healthcare agencies for 100% compliance.