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AutoGov/Long Term Care Case Study

Company Profile

Through our case studies, AutoGov profiles business situations where our client’s business process strategy has been significantly impacted by our tactical technology solutions. These solutions are carefully crafted to provide dynamic input into the decision-making matrix and designed to create maximum operational efficiency.

The company profiled in this case study provides long-term nursing and rehabilitation services to nursing home clients in three states.

Key Facts Included:


Business Situation

Business managers in this client’s nursing facilities are faced with the necessity of making quick admissions decisions with minimal financial information. These managers must manage the risk of admitting patients who may not be able to pay for their care; yet they understand the competing goal of balancing risk against the priority of maintaining a strong census.

Delays in state Medicaid eligibility decisions place additional pressure on the admission decision process. As a result, the company provides services to many clients awaiting a Medicaid eligibility decision. Admitted applicants who are ultimately denied Medicaid eligibility must be written off as a “bad bed” expense. As federal budget constraints for Medicare and Medicaid increase, our client faces even greater pressure to prevent non-paying admission decisions.


Technical Challenge

Business managers for our client conducted the admissions process using an antiquated paper-based system. As a result, admissions workers did not have a reliable mechanism to collect, share and assess information regarding an applicant’s information.

In addition, valuable support information (outside third-party data identity and asset verification data) was non-existent and the company had yet to establish a standardized, repeatable process for assessing the risk of admitting a particular patient. Electronic records of all applicants were not available for easy transmittal to managers and executives for analysis.


Solution

After careful analysis and study of the current business process and accompanying technical challenge, we realized our client required more than a standard business process enhancement. What was needed was a rigorous overhaul of the strategy behind their business process -- a strategy enabled by a new technical tool that did more than simply support the business manager’s decision process, but also provided a reliable backbone to the decision process.

So we endeavored to create a new product offering for our client. We determined that this offering would enable a business manager to engage sophisticated predictive analysis to accurately assess the likelihood that the Medicaid application of any potential new resident would ultimately be approved. In short, it would serve as a tool to aid in the forecast of risk for business managers and it would become an indispensable aid in the effort to reduce bad debt expense.

AutoGov’s answer for our client was to develop an easily accessible web-based risk scoring engine. This engine, driven by a predictive model designed to assess risk levels, now drives every business manager’s assessment process.

Risk scores, provided in near real time, are accompanied by a list of “predictive factors” that explain the reason for the score. Each manager uses the score and accompanying financial information as the primary pillar supporting their eligibility decision. In addition, our client now has a complete record of financial and risk information for every applicant that can be updated at any time during the review process.


Benifits

Within months of deployment, our client began to see the fruits of their process overhaul. A measurable reduction in write-offs was evident.

After 12 months of consistent use, our client’s new risk-scoring tool provided substantial improvements in the risk management process and those results were reflected in a healthy impact to the company’s financial situation. The company experienced close to complete elimination of Medicaid payment write-offs, a figure that they determined when projected over a five-year period would easily reach into millions of dollars in savings.

Some of the additional benefits to our solution include:


A Final Word

Prior to engaging AutoGov, our client operated its admission process in an unstable world of financial uncertainty. Today, the business process is not only better informed -- it is holistically better.

Our solutions are always crafted with the same mindset: to drive new business process efficiency and enhanced decision-making capability by intelligently deploying the power of predictive analysis and the untapped advantages of Big Data. It is the core of what we do.




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