Netsmart CareThreads
Netsmart CareThreads

Episode · 6 months ago

Tips, Tricks, and Challenges for Implementing EVV


Every dollar lost to fraud, waste, or abuse is a life impacted negatively.

Kristy Pyles, Principal at In Your Corner Consulting, LLC, joined Hannah Patterson on this episode of Netsmart CareThreads to talk about implementing electronic visit verification (EVV).

Kristy designed and implemented an EVV solution which was the first in the United States to achieve CMS certification using the Outcome Based Approach. This design can help providers, states and EVV vendors avoid bumps in the road and have a positive impact on the people they serve.

What we discussed with Kristy:

- The challenges related to implementation of EVV

- Tips and best practices for a successful EVV launch

This discussion with Kristy Pyles was taken from our show Netsmart CareThreads. If you want to hear more episodes like this one, check us out on Apple Podcasts here.

If you don’t use Apple Podcasts, you can find every episode here.

Listening on a desktop & can’t see the links? Just search for CareThreads in your favorite podcast player.

Welcomed in that smart care, threads, apodcast were human services and postocute leaders across the healthcarecontinuum come together to discuss industry trends, challenges andopportunities. Listen is we uncover real stories about how to innovate andimprove the quality of care to the communities we serve? Let's get intothe show. Welcome to today's version of theNetsmart care threads podcast. My name is Hannah Patterson and I am your hosttoday for today's episode of Our podcast. I serve as the vice presidentof our care dimensions operations here at nut, smart and I am so excited aboutour guests. Today, Christi Piles from in Your Corner, consulting a companythat netsmark collaborates with and works with on our EVV needs. Today,we're going to be discussing electronic visit verification and implementationwithin states will spend some time covering what it is, the challenges,tips and tricks from our guest and also understanding and allowing cristy toshare some of her experience. Christi thanks for being with US today, and canyou give us a little bit about yourself? Sure Anna? Thank you for having me. SoI do have a bit of a diverse background. I did start inlaw enforcement someontwenty years ago, but in the process I got into health care fraudinvestigations which pushed me to the Oha Department of Medicaid. They neededsomeone to help develop their electronic visit. varification programfor implementation and O also build the operations. So I went from being apolice officer and an investigator to helping them, build their fraudwaystonabuse tool and through that I've learned a lot of lessons not only aboutfraudwayst and abused tools, how to implement that, but also the impactsthat happens when you start involving the providers and those they care for,and I felt like, I would have more of an impact on the community if I startedmy own business and worked with providers and with EVV vendors andstates to make sure that we're trying to avoid some of these fumps in theroads, I'll call it as as I did during...

...some of the implementation. So that'san extremely unique background and super excited to have you when you wentthrough the implementation. Obviously, in Ohio, can you share some of thechallenges that you experienced, obviously with working with the state.Additionally, extending into managecare organizations or MCOs as they roll thisout to their individual providers. Oh absolutely one of the things that wereally tackled is in from the beginning was Stak, holder, pushback ormisinformation. You have a lot of things being said on facebook andsocial media. That may not be accurate, but they also frighten a lot of peoplewhich tries them to really not want to participate, and the last thing thatyou really want to do is to have people stop getting care or providing carebased on R rover mill. So it's really important to communicate with yourprovider and your recipiant community, often so that you can try to dispelsome of these myths and that they can have a good understanding andopportunities to provide feedback on your implementation, so you're makingsure that you're not coming at it from one perspective, but that you're usingthis as a partnership approach, so that everyone can come out of this betterone of the other issues is provider training. Some of the providers willwait until the last minute, which is understandable. Everyone's busy andthey've got their hands full. They want to make sure they're providing goodcare and if you offer training at regional locations, that's great forsome, but that still causes other providers to have to travel and theyjust don't have the means or the time to do that. So I found that online atyour own pace. Training seems to be the most popular, but again, providers dosometimes wait until the last minute, which causes some kind of overload foryour call center. They wait till your go live date. They start trying to useit and realize that they didn't take all the training that they needed to,or they just don't understand. So then they start calling your call center sothat they can get help through training,...

...which is really not what your callcenters are. Therefore, when you implement new technology, there'salways going to be an issue, no matter what technology it is, and you reallywant that call center staff to have the ability to notice when there's apattern, so they can put tickets in to fix the issues that are happening. Butif your call center is bogged down on training issues, then you may miss somevery significant technical problems that may be happening, so it's justreally important to try to get your providers engaged early so that theycan get that training and try to reduce some of that overburden on your callcenter. That was some of the biggest issues. I think I had in myimplementation yeah and did you during that implementation? As you broughtthat up, did you pilit, or did you have a subset of the providers that youworked with with the state that you targeted for having adequate oreffective training? So then we could you, can you know rinse and repeat thatthrough t the remainder of the state? So in my implementation, I did it in acouple phases. The first phase was fefor service only and the way thesystem was set up, not just evv, but also the billing system. We didn't havethe ability to pilot, so we ended up going, live but not impacting payment,so it was really just a soft watnch. I guess you could say, but I think themistake that we made is: We had a lot of classroom trainings. We had onlinetraining, there was an abundance of training methods that providers coulduse, but we really started seeing that the classroom training wasn't asutilized as we had hoped, and also providers had a couple month gapbetween when that classroom training happened if they went early to when wewent live and they had access to the system. So some providers who reallywanted to get started early and to get a good handle on this ended up having amonth or two before they could actually get their hands into the system to usewhat they learned so for face to. We decided that included the Manash carewe decided. We would like for this to... more of a justin time, trainingapproach. So we also wanted a training environment because that's veryimportant, so we strared to schedule the training a little bit closer to go,live but also provide the providers. A training environment were if they tookclassroom, they could log in and participate along with the trainer. Sothey're not just hearing it they're using it, so it did seem to be moreeffective, but I do recommend the online and training environment becausethat that just really overwhelmingly seemed to be the most popular approach.Yeah, absolutely so so from the implementation. Can you provide, or canyou give up the the listeners on the line today any tips and vest practicesfrom your experience, as you just alluded to a little bit sure. So one ofthe things that I I'm sure I irritated a lot of people that I worked with,because I'm a planner actually people in my life. I consider me a planner. Sonot only was I thinking about well, okay, this is our first project meeting.How are we going to interface, what all these connections do and learningtechnology as I'm learning how to implement? At the same time, I'm alsothinking about operations, because I know at the end of this implementation,I have to get a team up and running so that enabled me to make sure we had arule in place by the time we went live. We had stafpand place, we had policiesand procedures in place, so we had an operations unit ready to take the balland run once implementation was complete for face one. So if you thinkoperations alongside implementation, you may avoid a lot of hiccups, becauseyou may not you make it down the road ind your emplementation and realizethat you made a decision that doesn't work once you go live so that's that's.One of my biggest pieces of advice is just make sure you kicking the cand onthe road, then understanding what happens once you actually clok theswitch. I think one of the other things that wereally benefited from and I have heard across the country- There's differentways. This has being done, but every...

...state has some type of regulatingauthority. We invited our Medicaid broad control unit in early, so theycould help provide feedback on some report up. Some reports that we werebuilding help provide feeback if a decision that we are getting ready tomake really impacted them and their abilities to help enforce the lawsbuilt around medicate fraud. So inviting those investigativeauthorities in early helps you make decisions that not only reduce theimpact to your stakeholder community but also make sure that evv is goingalong the intent that it was meant for for Frodwastin abuse. You really wantto marry those two together so that you come out with the best outcome, so youbring out kind of that partnership. It just ties the two together, so bringingin really the fraud department from the state and having them, coordinate andbe a part of the implementation and championing on behalf of providers,really worked out well and your experience. We did not not only withthe medicate fraud or Rigga regulatory authorities, but also the stateholdercommunity themselves. We found out a lot of very good information and I, infact I was told I might be a better advocate than a state employee, becauseI could see what the providers were going through and I wanted to make surethe best of my ability that they were impacted in the least possible way andbecause, at the end of the day, it's about making sure people are gettingthe care that they need and if you don't make sure your providers are ableto perform the services that they need to perform. Then you're going to impactthose people that need the services. So, even though frodwayson abuse is a bigpiece of EVV, you really need to keep your eye on the prize and that's theperson who needs to get the services, because this is what this is all about.Every dollar lost, O proudwayston abuse is a life impactid negatively. So Ithink it's really about that. A partnership approach and how we can geta system that make sure not only the good providers have a better recordsand accounting that they can do so. They don't have to wait until they endof the year together, everything together, but also to make sure thoseproviders who may not be doing what...

...they're supposed to be doing either.Does it or we replace them with a good one. So it's really a community comingtogether to make sure people are getting the care that they needabsolutely and, as you started, implementing evv in thes state. Did yousee other, maybe operational challenges or things that brought to light duringthe implementation that really couldn't be overlooked during the implementationthat wasn't specific to evv but just processed driven that you exposed? Ifyou will yes, one of the things and I'm seeingthis with my some of my clients and as well as with TNAT SMART, we have a newsystem, it's bright and shiny, coming into a states it platform, but not allof those other. It systems are bright and shiny and new. They may have beenbuilt a long time ago and they may have some issues that have had banddates butover hem because it worked at the time. But when you implement new technology,you're goingto uncover the places that you didn't fix before, or maybe weren'table to. So, even though it's not really evv specific, it's like gettingsomething new in your home and realizing the rest of your decorations,don't match. You really need to make sure that your systems can worktogether because of the older technology or that the technology thatMadi wasn't built to accommodate this evv is going to uncover all of thoseissues. That's really interesting and hopes that the listeners that areparticipating in this ar at least going to be prepared in that passion. So,thanks for sharing that, what would you say kind of transitioning? What wouldyou say would be an additional value to EVV and states. You know really beyondcompliance factor of the twenty first century. CAREZACK mandate. Do you seeother areas of opportunity to express value for providers and to the statesyeah? At the end of the day, you have healthier human beings. I think thatonce prowiders, who may not have had a great business operating system beforeyou're handing them a system that will help keep track of their visits, helpkeep track of their payroll. You know...

...when you have claim submission throughyour EVV, your providers. No now don't have multiple logans, you know. Do theygo to the aging website and submit their building DTD? Do they log intotheir Systemane in that building? througrh all the MCOs? Are they goingto log in through all of their individual systems? When you bring itall in house to one system where they can log in schedule, their visitscomplete their visit, submit their claim, see what happened with theirclaim: You're, really reducing the administrative time that providers mayhave to spend through all of your payers submitting payments. So youreally have it's a one stop shop when you have that type of technology, so Ithink for providers who are going to use the net smart system they're goingto have really an indoend system that kind of takes away all that paper thatthey had to before, but on the state, an MCO side. You really get a holisticlook at what's happening with your member base. Are Your providers workingover time where you could approve some type of authorization for a secondperson to come in and help you know? Are Your people maxing out their unitsevery month? You know, maybe they need more you're going to see. You know whatkind of hospitalization statistics do you have? Are the more EVV servicesthey're getting relating to the less hospitalizations you're able to dodemographics by region to find out? Okay? Is this region receiving care forhome health related care? For this specific diagnosis, you know there'sjust so much data that comes along with evv, which I understand. We also havethat in your maybe your mmys system, but you don't have all the data in yourEsss in the my system that you doing your evv system like where are servicestaking place? You know where the person may live, but maybe the majority oftheir cares provided at work. So perhaps we try to get their personcentered plan around where they receive their care the most. So it's reallybeing person centric and making sure that people can get the services theyneed and the data to help you get there. Ev data can really help drive policyand data metrics that you really didn't...

...think you had before. So I thinkthere's a lot of benefits as a payer to the kettype of data. T that's availablejust to try to improve people's health hare absolutely, and did you see kindof an extension on that? Did you see the way or a difference in how thestate was communicating to its members and to its providers within thejurisdiction to to assist? In the adoption I mean, how did how did thestate operate from a communication plan, so it was really interesting. Weactually discovered we had ways to communicate with our recipients morethan we thought we did. We had an IVR system at the state level where we wereable to send text messages and do message driven rowill calls for lackwit, better word, so that they would be aware that there's a change. We alsoused our vendor to send emails blast to the providers so that they would knowthat there's a change coming up. We really went more from just sending theregular snail mail to being more technology, priven, so emailsstakeholder meetings. I think the department of disabilities actually hada facebook town holever so often so I feel like we're. You know. Governmentcan sometimes be very fragmented and one hand may not talk to the other asmuch as they should. When you implement a technology that impacts a wideconsumer base, you really bring a lot of the payers together so that they'retalking and trying to get the same message out. So I saw a lot ofcollaboration amongst payers that I not entirely sure was there before on thislevel. Yeah, absolutely I mean such great information for the listeners onthe line, especially if you're part of a state agency and organization from agovernment perspective that hasn't gone through the full implementation and areusing perhaps a state system. Thank you, Christi. So much for taking the time totalk to me today. I know we've been hearing so much about concerns onimplementation and the technology, advancements that you know some of theusers in the field and the providers...

...that are performing these specificservices. Don't have the technology, but it sounds like the collaborationand partnership between the providers and the state level, and thecommunication plans that are put into place really allow an effectiveadoption and scale to really move into really. You Know Two thouand and twentyone and the twenty firt century mandate might be interested to see. You knowhow other and the listeners are seeing how technology can truly be beneficial.Do you have any additional thoughts for the listeners today? So I think, if Ihad any parting words, it would be to everone involved so for the providersand the member community, all I say is be patient with your states and payers.This is a federal mandate, and if they don't do it, they do get a reduction intheir federal participation, which could impact services down the road. Sothis is something that states have to do, and I've now worked with fourdifferent estates, either through clients or personally, and every singleone of them have had the members and the provider community in mind andthey're trying their best to make sure they don't impact you negatively. So Ithink, having Patiente with your state and your paiers is a big deal, but alsofor the payers have patience with your technology, you're asking vendors tocome together and make things work, and sometimes that can take a little bit oftime. So, the more time you can give your providers to acclimate to thosechanges the better. So I think just having patiencs with each other andunderstanding at the end of the day, we all want to make sure people aregetting their care and the best way possible. So I think just patiente andbe a community are the biggest takeways. Absolutely thank you for for segmeningthat to and really calling out the collaboration and patience as we as wenavigate the water. So again, thank you Christie for joining this episode ofthe carethreds podcast on behalf of Netsmart, and thanks for the continuedcollaboration that you and your organization have with our company formore information for listeners. Please go to ntstcom and thanks for joiningthis episode of the carathreds podcast...

...have a great day at Netsmart. Weunderstand the challenges facing provider organizations. Our team willhelp you navigate changing value, based care models with solutions and servicesthat make person centered care of reality will equip you with technologyand services that provide holistic, real time. Views of Care Histories thatinform better decision making and better outcomes visit us today atntstcom Netsmart serving you. So you can serve others thanks for listeningto the net smart care, threads podcast through collaboration and conversation,we can work together to make healthcare more connected than ever before andbetter support the communities we serve to ensure you never miss an episode.Please subscribe to the show in your favorite podcast player, if you useapple podcast, we'd love for you to give us a quick rating for the showjust havf the number of stars that you think the podcast deserves until nexttime.

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