We were looking for a partner who could help us streamline our operations and improve our care management processes. Medsien delivered on all fronts. Their platform integrated perfectly with our athenahealth system, and the automation and billing intelligence features have been game-changers for us. Our team now has more time to focus on what matters most—our patients. The support we've received from Medsien has been top-notch, making the whole process smooth and efficient. And it's clear that our patients have noticed the difference, too.
Jamie Merritt
Vice President at Whole Family Health Center
Challenge
Navigating the complexities of CCM and RPM management in an FQHC setting
Whole Family Health Center (WFHC) has been a trusted healthcare provider for the Treasure Coast community for over 25 years, serving patients from their base in Fort Pierce, Florida. With 37 providers on staff, WFHC offers a wide range of services, focusing on the unique needs of their diverse patient population. As a Federally Qualified Health Center (FQHC), WFHC faces stringent regulatory requirements, particularly in managing Chronic Care Management (CCM) and Remote Patient Monitoring (RPM) programs.
Despite their dedication, WFHC struggled to efficiently manage these programs. Initial attempts to handle CCM and RPM internally led to challenges in documentation, billing, and patient engagement. A partnership with another third-party provider proved disappointing, leaving WFHC with inefficiencies and frustrated staff. With growing administrative burdens and concerns over compliance, WFHC needed a solution that could seamlessly integrate with their existing electronic health record (EHR) system, athenahealth, and provide the necessary automation, structured documentation, and billing accuracy.
Solution
A seamless integration with athenahealth for streamlined Care Management
WFHC turned to Medsien for their expertise in managing CCM and RPM services. Medsien offered a comprehensive platform that seamlessly integrated with WFHC’s athenahealth EHR, enabling smooth data exchange and ensuring that patient records were always up-to-date. This integration was key to the successful implementation of Medsien’s services.
Medsien’s approach included starting with a hybrid model, where WFHC staff collaborated closely with Medsien’s team to ensure a smooth transition. Over time, as the benefits became evident, WFHC transitioned to fully outsourcing their CCM and RPM operations to Medsien. Medsien’s dedicated team of Care Partners, including bilingual staff, took over the monthly patient care management responsibilities. This team built strong relationships with patients, leading to higher engagement and satisfaction. They also ensured that patients received personalized care, which was reflected in the improved patient satisfaction scores.
Medsien achieved a remarkable patient retention rate of 94% by consistently reaching out to patients every month and maintaining a high engagement rate. This success is particularly notable given that FQHC patients are generally harder to reach, often residing in rural areas with limited access to healthcare services. Despite these challenges, Medsien’s proactive approach ensured consistent communication and care management for these patients.
One of the standout features of Medsien’s platform was its ability to run accurate eligibility reports using the data in patients' charts within athenahealth. This capability ensured that only qualified patients were enrolled in CCM and RPM programs, reducing administrative errors and ensuring compliance with FQHC regulations. Medsien also provided robust tools for population health management, including the utilization of surveys like the Social Determinant of Health (SDOH), PHQ-9, and Fall Risk Assessment. Impressively, 100% of Whole Family patients had these surveys completed, which led to a substantial increase in their overall quality scores. These tools offered WFHC comprehensive insights into their patient population, allowing for data-driven decision-making and better patient outcomes.
Medsien’s billing intelligence was particularly impactful. The software was designed to recognize FQHC patients and apply the correct billing codes, such as G0511, ensuring that WFHC maximized their reimbursements while staying compliant. Additionally, claims are automatically dropped in athenahealth for processing, eliminating any work for the billing team. This feature also reduced claim rejections, as the software meticulously checked each submission for accuracy before it was sent out.
Another critical aspect of Medsien’s service was the structured documentation and audit-proofing features. These tools ensured that every patient interaction was documented in a way that met or exceeded regulatory standards, reducing the risk of audits and penalties for WFHC. The documentation process was streamlined, making it easier for staff to maintain accurate and up-to-date records.
Results
Enhanced patient satisfaction and outcomes with data-driven Care Management
The partnership between WFHC and Medsien led to significant improvements across the board. With Medsien’s platform seamlessly integrated with athenahealth, WFHC saw a marked improvement in the accuracy of their billing and documentation processes, achieving a claim denial rate of less than 3% and an increase in overall revenue. The ability to run precise eligibility reports and utilize population health tools provided WFHC with deeper insights into their patient population, enabling them to deliver more targeted and effective care.
Medsien’s automation capabilities significantly reduced the manual workload for WFHC staff by automating routine tasks like appointment scheduling, patient follow-ups, and care plan updates. This freed up valuable time, allowing staff to concentrate more on direct patient care. The automation extended to billing as well, with Medsien’s software automatically distinguishing FQHC patients and applying the correct billing guidelines to ensure claims were processed accurately and in compliance with regulations. As a result, WFHC was able to implement two new programs without adding any extra time to their staff’s workload—a time-saving equivalent of at least one full day, or 8 hours per week, for managing 100 patients. Additionally, the streamlined processes meant that WFHC staff spent less time managing patients enrolled in CCM and RPM programs, further reducing the time required for routine patient management tasks.
The shift in focus to patient care was pivotal in enhancing both patient outcomes and satisfaction at WFHC. With more time dedicated to providing consistent and personalized care, Medsien was able to enroll more patients in their CCM and RPM programs than ever before. This consistency in care delivery led to significant improvements in patient health outcomes and satisfaction. Patients received more focused attention to their individual needs, which not only improved their healthcare experience but also contributed to better overall health results. Over 90% of participating patients reported high satisfaction with their Care Partners and recognized the overall health benefits of the programs.
These results not only improved the financial health of WFHC but also solidified its reputation as a provider of high-quality, patient-centered care in the community.
WFHC’s experience with Medsien highlights the value of a fully integrated, technology-driven approach to managing healthcare services. By leveraging Medsien’s platform and deep integration with athenahealth, WFHC was able to enhance patient care, streamline operations, and maintain compliance, all while expanding services to patients outside of the practice.
