How Apria HealthCare makes Progress Software to create a Progress Savvion®-based Business Process Management (BPM) system
Apria Healthcare, the leader in the U.S. alternate-site respiratory, home medical equipment (HME) and specialty infusion therapy markets, serves more than 2 million patients annually from its more than 550 branch offices across the country. Physicians, health plans and hospitals refer patients to Apria because they trust the company to deliver vital services, products and supplies to patients’ homes within as few as two hours from the time they place an order with Apria. Apria’s local branch employees follow up with the personal touch that ensures that they are the patients’ supplier of choice for additional homecare services and products they may need to support their chronic or acute medical condition. This powerful, high-touch strategy has made Apria the market leader in all of its three primary service lines.
In recent years, however, Medicare and other insurers’ reimbursement cuts, coupled with an increasing administrative burden from the same payors, constrained Apria’s strategy. The company needed a way to dramatically reduce the cost of branch operations while preserving its distinctive capacity for local service.
Nothing short of a major transformation of operations would suffice. To accomplish this, Apria partnered with Progress Software to create a Progress Savvion®-based Business Process Management (BPM) system that has centralized and streamlined order administration across a significant portion of its branch network.
Before Apria centralized order administration for a large portion of its branch network in three large Customer Care Centers (CCCs), each branch did the work themselves, from preliminary order intake to insurance eligibility verification, qualification, order confirmation, order placement, delivery date and time confirmation, order routing and delivery. However, local processing was a challenge. For example, 60% of thousands of orders for new services are faxed by the company’s customers. With old-fashioned fax machines in each branch, managers were never sure how those orders were being processed or how many were pending. With so many fax machines and data re-entry, orders easily got lost if the paper was missing. In addition, business users had no real-time order status visibility, which prevented workloads and inventories from being optimized and making Key Performance Indicators (KPIs) hard to manage.
Health insurance plans and Medicare claims processors demand precise data and documentation before they pay companies in the homecare industry. Upwards of 30% of Apria’s customers are Medicare patients, making it critical that the company be able to meet Medicare’s increasingly stringent documentation and billing requirements. Moreover, the company works with all 50 state Medicaid plans, all of which have unique regulatory, documentation and/or billing requirements. But to collect and report on all this information was labor-intensive and prone to errors, leading to claims processing delays, denied and/or unreimbursed claims.
A centralized model for order administration clearly made more sense. Not only would Apria be able to reduce costs, but they would be able to improve quality and responsiveness at the same time. And, it would free up branch staff to focus on customers rather than certain paperwork that might be better managed centrally.
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