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The following report identifies issues and proposed solutions with respect to overall
compliance with the United Healthcare Advanced Notification Protocol that went into full effect
November 1, 2014. A compliance rate of 80% was expected by the end of June 2015; however,
the current compliance rate teetered between 45% and 48% as of July 1, 2015.
Data Collection
Multiple data sets or series, internal BeaconLBS conversations, as well as interviews with
medical providers and staff were reviewed for this analysis. The compliance data collected is
over a time period beginning November 1, 2014 to July 4, 2015. Interview data is a collection of
conversations occurring during the same time period. The interviews are a result of first contacts,
provider registrations, training sessions, intake calls as well as follow up calls and emails.
Sources of Data
A. Provider Compliance Report: The provider compliance report data is comprised of
claims data which consists of UHC patients lab orders for the state of Florida as
provided by United Healthcare. The report is created on a monthly basis. For the purpose
of this analysis we will utilize the latest report dated July 4, 2015.
# Groups listed
# DST Ordered
# DST with AN
4755
51145
10881
Percentage with
AN
25%
The current report covers the time period of May 1 to June 30, 2015. A 60 day snapshot
provides a 25% compliance of DST being presented with the mandatory notification. The result
is 75% of lab orders being denied for non-compliance.
B. Weekly Adoption Report: The weekly adoption report is comprised of data analysis using
the averaged RVU (relative value unit) a physician or provider group orders in labs
within a 30 day time period. RVUs are an indication of the volume of orders from an
organization or physician. The report calculates the projected and actual RVUs, and the
percentage of orders submitted with an Advanced Notification within a weeks time
period. The report provides an overall compliance percentage beginning November 1,
2014 to current, the current week, and the last three weeks respectively.
Type of
Grouping
Provider
Groups
Individual
provider
# listed
RVU
8971
3749811
Current Week%
Compliance
38%
3030
30810
49%
July 4, 2015 Weekly Adoption Report: Chan, L & Catlett, C, CP Risk Solutions, Appendix B
When constraining on the overall adoptions according to the information from UHC there are
a total of 12,001 groups for registration. We then compared this data set to the BeaconLBS
registration data set which shows 9,299 identifiable registrations. This could indicate there are
2,702 physicians or groups remaining to be registered or duplicate listings.
C. Provider personal perspective (interview) data is a culmination of discussions and
feedback from the medical providers within the state of Florida. The provider
perspectives range from Director of Operations, Office Administrators, and nursing
personnel to front desk registration. The providers and groups range from large to small
RVU ordering habits.
Listed below is a compilation of the main reasons for non-compliance and how BeaconLBS
has attempted to resolve the issues. Several of the objections would support the need for a
performance gap assessment looking for areas of opportunity where the group could improve
(Piskurich, 2006). Addressing areas such as not enough manpower or it interrupts our work
flow with the provider group could encourage participation while showing empathy and support
from BeaconLBS and United Healthcare.
Issue
Resolve
D. A performance gap assessment takes a look at what the performance should be and what
it is now (Piskurich, 2006). An individual client performance gap will assist BeaconLBS
with specific training needs or solutions by provider organizations. A Provider
Performance Gap Analysis has been performed and included for a group being considered
for the PDS-Q application. This is an example only of the information required in
addition to discussion and is not complete. The organization was interviewed,
information was discussed and followed by activation and training in the proper operation
of PDS-Q.
Strengths and Weaknesses
It is to be noted there flaws in the data.
The first flaw is the numbers of organizations or providers still requiring registration as
physicians in the individual provider section of the Weekly Adoption Report could in actuality
belong to a group. The Compliance Report also designates 333 line items to the group affiliates
column comprising of 94 groups. This would suggest a clean-up of the organizations would
provide accurate data.
A second flaw is the possibility of duplicate registrations in the BeaconLBS Physician Portal.
Mass registrations by BeaconLBS for groups occurred while individual physician offices have
also self registered. The total registered groups could be less than the data suggests.
A third flaw is the number of physicians in compliance. The Adoption report lists 2,911
physicians/organizations with no expected RVUs and no expected compliance percentages. If
these are considered in the mean calculation they should be removed.
Conclusions
After reviewing all available data, there appears to be additional issues that could affect
identification of those requiring activation and training of the PDS-Q system.
1. Conflicting statistical data
a. The exact number of provider groups or independent physician groups unknown
due to the possibility of duplication in the data
2. Criteria for selection of PDS-Q activation is compromised by item 1
3. Provider resistance is easily overcome but must be accomplished
4. Provider Performance Gap Analysis is vital in overcoming provider resistance-
a. It is currently unknown where all data is obtained to create the reports or who
internally populates the required data
Recommendations
BeaconLBS is requesting a training solution to improve overall performance or compliance of
the UHC Laboratory Benefit Management Program. The training solution must be
comprehensive and robust to facilitate mass distribution. Instructional design is mainly
concerned with skills/knowledge deficits as they directly affect training (Piskurich, 2006). It is
not to say that additional factors can not influence performance such as negativity about the
BeaconLBS product by management within a provider group. Communication and training will
attempt to resolve the negative aspects of compliance.
Non-Training Needs
1. Consolidating providers to their respective groups in the Compliance Report and Weekly
Adoption Report will:
a. Strengthen the provider organizational RVU data and overall compliance data
b. Assist in proper identification groups for PDS-Q review
c. Prevent multiple contacts by multiple BeaconLBS staff
d. Streamline and prioritize outreach by RVU data and registered groups
2. Consolidating self-registered physicians in the PDS Portal with their respective groups
will:
a. Clean the data sets and allow for proper future implementation of PDS-Q.
Training Needs
1. Create a PDF User document welcoming and explaining how to access and use the PDSQ. If the user is new to the system additional training may be desired and accomplished
by:
a. Insert a training demonstration video or link inside the PDF document rather than
posting it online since the PDS-Q will only be available to specific groups
2. Creating an explanatory email or document outlining the specifics of the United
Healthcare Laboratory Benefit Program will:
a. Explain the ramifications of non-compliance such as claims denial and fee
schedule
b. Meet objections head on
c. Strengthens verbal outreach communications
3. Provide needed access and training to BeaconLBS staff to create a personalized Physician
Performance Gap Analysis as this should be part of the outreach to potential PDS-Q users
References:
Chan, L & Catlett, C. (2015). BeaconLBS Weekly Adoption Report, CP Risk Solutions
Fisher, A. (2015). BeaconLBS Provider Compliance Report, BeaconLBS and United Healthcare
Piskurich, G. M. (2006). Rapid instructional design: Learning ID fast and right (2nd ed.). San
Francisco, CA: Pfeiffer.
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Appendix A
Abstract PDF from the Compliance Report- click to expand
11
12
Appendix B
Example PDF of the Weekly Adoption Report-click to expand
13
14
Appendix C
Example PDF Provider Performance Gap Analysis- click to expand
15
16
17
Appendix D
Main Provider Interview Responses concerning lack of adoption.
Conversations were generated through phone and email correspondence to BeaconLBS
representatives.
Issue
Resolve
18
Criterion
/(Standard)
Unacceptable
Acceptable
Target
Needs Analysis
(AECT 5.1)
Graded in Week 1