How One MCO Achieved 99% Provider EVV Adoption in Eight Months
The 21st Century Cures Act, passed in 2016, requires States to implement electronic visit verification (EVV) for all Medicaid-funded personal care and home health services.
Florida’s Agency for Health Care Administration (AHCA) acted early to prepare the state for the federal deadline by mandating EVV for all home health and personal care services starting July 1, 2019. However, with CMS granting the state a good faith effort exemption (GFE), this deadline was pushed to February 1, 2020.
Implementing EVV in Florida was a unique challenge because AHCA had mandated state-wide EVV in 2014, but after months of road bumps, the initiative ultimately failed. However, with the passage of the Cures Act, AHCA and the state’s managed care organizations (MCOs) had to take a new approach to EVV to avoid the risk of federal penalties.
One of Florida’s largest MCOs recognized it needed a technology partner to adopt EVV in accordance with AHCA’s mandate.
The MCO chose HHAeXchange to implement EVV and ensure compliance with the AHCA mandate. The decision to partner with HHAeXchange involved a cross-functional, round-table effort. The vendor selection team included multiple representatives from long-term care and project management departments. A key criterion in the decision-making process was taking the time to understand how HHAeXchange would meet the MCO’s needs and how it would fill gaps left by a previous vendor.
With the State’s EVV mandate shifting multiple times over the course of the year, the MCO had to ensure its provider network had the latest information and were aware of how they would need to perform EVV and billing.
The organization’s Supervisor of Program Coordination led the provider adoption efforts across its network. “We knew getting our provider network on board was going to be difficult, so we started early.”
Beginning in 2018, the MCO put together an early adoption plan and worked closely with HHAeXchange to onboard providers and help simplify the transition to EVV. The MCO created an internal team consisting of a national champion for EVV, LTSS leaders, senior directors of the provider network, and technical IT leadership. They also made it a point to promote the use of HHAeXchange by communicating timely updates to its providers and engaging in one-on-one provider outreach.
“HHAeXchange was instrumental to our success,” said the MCO’s Supervisor of Program Coordination. “By holding informational sessions with our providers, leading direct provider outreach, hosting educational webinars, and helping to interpret guidance from the state, they were a true partner every step of the way.”
Early Adoption Strategy
Create an Internal Team of
Communicate Often and in Multiple Channels
An EVV Champion
Provider Network Leaders
Proper Utilization of the Authorization
One of the biggest benefits of working with HHAeXchange is that the MCO now has full visibility into its processes and how its provider network is billing according to the authorization.
“Prior to HHAeXchange, our process was pretty manual,” said the Supervisor of Program Coordination. “We used fax and phone calls to reach providers, which was very tedious and time-consuming. Since everything was manual, providers often wouldn’t find out about issues with authorizations until it was too late, and services were already billed.”
Now, every visit is electronically verified and logged in real time, and daily reports are automatically sent to the MCO. As a result, the MCO can immediately rectify missed or late visit patterns and eliminate the potential for wrongful billing. Additionally, the MCO was ahead of the curve in ensuring compliance with the AHCA requirement that missed visits be directly reported to the state, rather than relying on provider self-reporting.
The MCO has seen significant improvements throughout the organization. “The way we bill authorizations has completely changed,” said Director of Long-Term Care Services. “We can now see if workflows aren’t being followed and address billing issues immediately. Plus, with HHAeXchange’s claims engine, all submitted claims are automatically validated against the authorization and EVV data.”
Fast and Simple Communication
With HHAeXchange, the MCO has reported greater internal and external communication. One of the tools the MCO reports using most is HHAeXchange’s Case Broadcasting functionality. It enables the MCO to instantly broadcast a message or notification to the entire provider network or subset of providers.
“Case Broadcasting has completely transformed the way we operate and communicate with providers,” said the Supervisor of Program Coordination. “With a few clicks, we can send a message out to our entire provider network about anything from a long holiday weekend to reminders about educational events and trainings. It definitely beats having to send 5,000 emails out and follow up with phone calls and multiple reminders.”
With HHAeXchange, the MCO has built more accountability into its provider network. “Providers are conscious of the transparency EVV brings. They’re more mindful now of not over-utilizing authorizations, which keeps our costs down,” said the Director of Long-Term Care Operations.
The MCO also uses HHAeXchange’s exception reports to monitor missed visits, late visits, and any other trends it wants to capture. This has led to improved quality of care for the MCO’s members.
Improved Provider Satisfaction
Providers have also experienced new efficiencies. “With HHAeXchange, we’ve really streamlined the authorization process, which has led to less back & forth between us and our providers,” said the Supervisor or Program Coordination.
Before implementing HHAeXchange, many providers had concerns about EVV acting as “big brother”. However, the nonintrusive nature of HHAeXchange’s EVV methods immediately put providers and their caregivers at ease. Providers are able to choose from multiple EVV methods and feel comfortable knowing the mobile application only tracks caregivers’ locations when they are clocking in and out.
A year after implementing HHAeXchange, the MCO has onboarded 99% of its provider network, which consists of more than 14,000 members. To date, it has achieved an 88% compliance rate with EVV usage. This was a huge success for the organization as it has one of the largest provider networks in Florida.
One of the reasons for this success is that the MCO took the EVV mandate seriously and acted early to onboard their provider network. The organization also viewed HHAeXchange as a trusted business partner, rather than a software tool, and relayed that to their providers.
The partnership between the two organizations was vital to the success of the implementation. “When you have an MCO that is hands-off and just looks at us as a software tool, the tool becomes the hindrance rather than the game changer,” said Daniel Spurlock, HHAeXchange Client Success Manager.
The MCO’s Director of Long-Term Care Operations agreed: “I attribute a big part of our success to our relationship with HHAeXchange. In working with multiple vendors over the years, HHAeXchange is so much more than just that. It’s a personal relationship with them. They are in it with you from day one. Their subject matter expertise, professionalism, technology, training, communication, follow-up, follow-through, and customer services are simply excellent.”
Tips for EVV Implementation Success
Communicate with providers and offer helpful resources
Ensure all providers are included in the implementation process
Achieve internal alignment from all stakeholders from beginning to the end
Prevent problems by starting early and paying close attention to detail
Manage project phases and set actionable deliverables and realistic timeline