Michelle Miller is VP of IS at MedSolutions, Inc., a Nashville, TN, radiology management products provider that works with large managed-care organizations to manage quality and cost related to high-end outpatient diagnostic imaging.
In the third installment of her CIO Journal series, Miller’s notes illustrate the diversity of her role and required responsibilities. The one thing she doesn’t accomplish today is advancing in the “Eggstrovert” game.
Wednesday, 8:30 A.M.: Working around a failing workaround
I arrive at the office in time to find that I’m double-booked for 9 A.M. meetings. I have my network administrator handle the interview for the tech support position, and I opt to attend the status meeting on the electronic claims processing. Our claims-payment system is a third-party application that we can’t customize. It has an interface for batch loading of electronic claims, but we’ve found the interface to be so troublesome that we have essentially rewritten it in the form of workarounds. One workaround appears to have gone haywire—resulting in paid claims delays. Also, when physicians call in for a status on a claim, they are receiving incorrect information from customer service staff. Again, as a result of rapid growth, we have been unable to invest the time necessary to train customer service staff about the nuances of our business. Imminently fixable, all of it, but it takes time and a commitment to communication.
9:30 A.M.: Preparing for CRM meeting
I review the list of CRM enhancements in preparation for the large Service Task force meeting. The director of ops is my business owner/cohort in this CRM adventure and has been stellar to work with. She has taken true ownership of the CRM application and is great about articulating business needs and owning those decisions. She and I were to lead the discussion of enhancements. I will have to bow out due to a personal appointment, so we are reviewing the list prior to the meeting to make sure we are on the same page and understand what the current list is. We share some concern about the size of this meeting, hoping that it is an environment that will encourage input from the in-the-trenches employees. If not, we’ll try it in a different forum.
3 P.M.: Talking data with a potential client
I take a conference call with a prospective client. During the process of courting a client, we request a two-year radiology claims dump from them and run it through our data-analysis engine. Our data analysis is comprised of Microsoft SQL Server, a set of Excel models, and Cognos Power Play. The result is an analysis that allows us to review in detail what the prospect’s existing radiology costs are and allows us to show from one year to the next how those costs are rising. As usual, we show an increasing cost trend for outpatient, high-end imaging of about 17 percent. Each time I go through this exercise, I am reminded that there is a very real value to the service we are providing and that we are in an exploding market. Healthcare costs are nuts, and overutilization of high-tech, expensive imaging is one reason why.
The purpose of the conference call was to discuss some anomalies we found in the client’s data—a strange balance of high-tech imaging claims (MRI and CT) vs. low-tech claims (X rays), and relatively low costs as compared to others in their market. Some of the reduced cost can be explained by their demographic (a more youthful population, meaning less medical need), and they are doing research on their end about the data they sent us to look into the modality imbalance. This back-and-forth over the data is typical during our sales process. The detailed data analysis is a very useful tool to help us show the value of our program, but it is a difficult and complex process. It often is less about technology or data and more about the nuances of the health plan and how they manage their business. It’s fascinating, and a great diversion from LANs, telephone systems, and those blasted EDI claims.
4 P.M.: A quick foray into fun
I try to figure out what question I want to ask for the Eggstrovert game: What is the one TV show you watch that you won’t admit to your friends? Mine is Survivor. I try to find my two folks but am unsuccessful.
6 P.M.: Moving forward on HIPAA effort
I call my contact at a preferred local consulting company to talk about getting help with implementing the HIPAA transaction set standards. We have some ideas about how to tackle this, and we aren’t too worried about it since we are so well versed in transforming data. Much of what we do involves receiving data from our clients in one form and manipulating the data so that it is in a recognizable form that we can work with. We consider the HIPAA transaction sets as simply another format. However, I know I will not have the bandwidth to research this fully and want some help strategizing about best solutions from someone who has done it before.
Need to catch up on Michelle’s journal entries?
Catch up on Michelle Miller’s five-day journal by reading the journal installments from Monday and Tuesday.