On the challenges in the healthcare space.
Our applications were initially developed in conjunction with Covenant Health to provide insights into revenue cycle issues that previously required many labor hours to identify. They were also seeing claims being denied where there was never a previous problem. The apparent denials were very subjective as Covenant did not have readily accessible data to back up staff’s suspicions on trending denials.
One of these suspected issues was around a particular diagnosis. Several analysts felt they were seeing increased denials. Using our application, Covenant Health was able to search the cases they had around the diagnosis. We were able to highlight the details for paid and unpaid accounts and within 20 minutes the client knew why the claims had been denied and what needed to be done to facilitate payment. We subsequently built a claims comparison tool that enabled them to not only accomplish this in less time but also monitor logical groupings of paid and unpaid claims with common procedures and diagnoses. We also measured the potential reimbursement, which allowed them to better focus their resources.
Please elaborate on the features and functionalities of your solution.
Working with Covenant, we developed a library of performance metrics and display objects that were designed to allow the user to follow the trail to see where they have poor performing payers or issues with specific providers.
The combination of being able to ingest both structured and unstructured data and provide smart tools to analyze both and the resulting actionable intelligence differentiates us in the market
Subsequently, we also developed the RevRecover™ product that provides a tool for clients to process denials and ADR requests. The clients can operationalize the requests from payers for documentation around additional development or just work denied claims. The clients can build their workflow and focus resources on high priority claims in order to get those claims paid. The solution also supplies documents for the payers involved and allows users to create documentation for appeals.
Is there a step-by-step approach that you take while integrating the tool for your clients?
The process is initiated from the first meeting that we have with a potential client. We try to comprehend their pain-points and whether we would be able to help them with the products that we have in our toolbox. This gives us a good understanding as to which are the solutions that we should leverage to deliver a comprehensive and seamless solution for the client.
The approach continues during the implementation process as we define the workflow according to the performance metrics and the key stakeholders responsible for dispatching records to work, audit requests, or appeals. While the discovery phase is where we understand the clients' needs first, we believe in maintaining this transparent and healthy collaborative environment throughout the engagement.
What are the factors that differentiate VortexT from other vendors?
First, it is the combination of being able to ingest both structured and unstructured data and providing smart tools to analyze both. Secondly, we have a very robust data analytics function, which is led by Senior Data Scientist Jordan Erickson who has over ten years of experience in healthcare data analytics. His team has built a predictive analytics tool using the data we ingest and they also develop tools for clients to pick the “low-hanging fruit”. The clients can realize a rapid speed to value implementation and realize an ROI immediately upon implementation. Jordan's experience in leading teams to improve clinical outcomes and administrative processes at multiple healthcare systems across the country greatly helps us in fostering an innovative work culture.
Another factor that differentiates us is the decades of experience that we have in the healthcare industry. Our executive team has more than 70 years of combined experience for our team members to draw from. We pride ourselves on constantly learning and innovating according to the needs and trends in healthcare.
What lies ahead for you? Any expansion plans that you can tell us about?
We will be adding back-office functions for managing the request-for-information process into our existing product. This will allow clients with medical records requests to be seamlessly managed within the VortexT platform. We will also be adding critical quality indicators and want to expand into advanced analytics which are not currently supplied by big-box EMR vendors for large practice groups.
We are uniquely positioned to solve problems such as to identify issues with common patients and to work across clients within a specific region. We will leverage our technology to provide more community-based solutions in the future.