Happy Wednesday, Hospitalogists! I'm back in your inbox with the latest installment in my series with Medallion on everything credentialing. Today, we'll be diving into a real-life example of Medallion's great work with Tampa General, and how a fateful meeting at a conference led to solving a huge bottleneck for the hospital. Enjoy! This essay is a sponsored post in partnership with Medallion. I write these posts for companies with products or missions I believe can provide value-adds for Hospitalogy subscribers, many of whom work with/for hospitals or provider organizations that deal with issues like credentialing on a daily basis. If you're interested in a sponsored deep dive, please reach out to Blake@workweek.com! |
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Medallion and Delegated Support - Key Takeaways: |
Tampa General was dealing with high operating costs and unreasonable timelines for credentialing, risking patient service quality, frustrated clinicians, and falling behind in a competitive physician alignment market. With Medallion's platform, which Tampa General used post-delegation, the health system cut its provider credentialing turnaround time from 30 days down to three. While these are insanely good results, in general, delegation drastically reduces provider onboarding and time-to-first-bill. Medallion's solution actually cost less than what Tampa General was spending on credentialing-related costs. How's that for streamlining administrative processes? If you're a large provider organization or if you're looking to scale your provider base, the message couldn't be more clear: future-proof yourself today by setting up delegated credentialing - it's a lot of work upfront, but benefits of doing so vastly outweighs set-up time spent in the long run. There is a significant financial and qualitative opportunity cost in failing to do so. Medallion resources: - Get in touch with their team here.
- Read the Tampa General case study here.
- Read my deep dive on Family Care Center's credentialing journey with Medallion here.
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Introduction to Medallion's Delegated Credentialing Platform |
Provider credentialing is a process involving high operating costs, time, and headaches for providers chasing down tedious documentation. Medallion simplifies credentialing for large physician practices and health system enterprises, and the NCQA-certified organization and their platform is on the forefront of the delegated credentialing movement. Delegated credentialing is a relatively new process to get providers at larger organizations credentialed. By streamlining this process, provider organizations benefit almost immediately through increased cash flow and less time spent chasing down providers for documents. More and more plans are adopting delegated credentialing as a practice (following NCQA guidelines), and larger provider organizations (generally 25+ clinicians) should seriously consider setting up delegation as the puck moves in this direction. |
Breaking Down Tampa General's Credentialing Strategy: The Beginning |
Tampa General (Tampa General, or TGH) sits at $2.2 billion in revenue today and over 8,000 aligned primary care practitioners amid an expansive footprint in Florida: |
As you can see in their 2024 JP Morgan Health Care Conference presentation, the well-known academic health system has been on a growth journey. Tampa General, like other large regional or academic health systems, is looking to transform its operations, staying competitive with current market forces through a focus on physician alignment and partnerships, care coordination, and expanded market share. But this journey wouldn't have been possible without a key strategic credentialing decision made in 2015. In 2015, Tampa General employed just 35 physicians. But its professional group had plans to continue scaling, and the writing was on the wall: healthcare is migrating to the outpatient setting, and physician alignment will be paramount to grow our system. |
Tampa General knew credentialing was a major problem for its providers. Their leadership had heard as much, and physicians and APPs do NOT want to waste hours and hours chasing down tedious documentation requirements. They'd rather do what their highly skilled selves were trained to do…deliver patient care. Credentialing was a major bottleneck to the onboarding operation, and created frustration on both the business and clinical side. Imagine the damper effect this dynamic has on growth and financial considerations. So, the TGH credentialing team decided to embark on their delegated credentialing journey. TGH put in the work to get NCQA certified, and started delegating with two to three plans. Why did TGH decide to go delegated? - Their professional group was growing: Delegation was a much more efficient process to onboard physicians to the Tampa General platform.
- Wait time decreased: Previously, Tampa had to wait 160+ days for providers to get properly enrolled, and the team managed to reduce enrollment time.
- Streamlined internal processes: Instead of submitting a one-off application to every payor for every clinician, Tampa General could work off a roster and maintain its own spreadsheets internally
TGH is an outlier. The system saw a significant opportunity to grow, and identified a key bottleneck despite the upfront investment required to unwind it. Delegation unlocked growth. Tampa General now sits at over 400+ employed providers, and is scaling amid new ambulatory plans. But the story doesn't end there. |
Tampa General's Delegated Credentialing Transformation |
Despite initial success, work on the credentialing side wasn't close to done. After building the delegated credentialing chassis and seeking NCQA certification, Tampa General identified rampant inefficiencies in the process. They were still wasting time, and the opportunity costs involved with credentialing delays led to loss of incremental revenue (and more interest payments for payors holding those sweet premium dollars!) for hardworking clinicians. The cost of doing credentialing by themselves was getting out of hand. TGH needed a partner to help streamline things. As fate would have it, a chance meeting with Medallion at a healthcare conference saved Tampa General's credentialing team and clinicians hundreds of hours, and millions of dollars in revenue. After partnering with Medallion, Tampa General saw the following results: - Credential turnaround time as part of the onboarding process dropped to three days, down from 30. Incremental cash flows generated from 27 days were calculated at ~$2.3M.
- Tampa General saved $100,000 by switching to Medallion over its old credentialing solution.
- Satisfaction increased across the board - working with Medallion's software and account management team made Tampa General's credentialing life much easier.
With credentialing streamlined and results within six months from Medallion, what all does this mean strategically for Tampa General? - Ability to scale and grow provider base, capture more market share, and prevent network leakage with a flexible credentialing solution in place.
- Happier physicians with less time spent tracking down documents = better physician alignment, better retention and satisfaction.
- Time to bill drastically decreased = more cash flow in the door and less time worrying about backfilled authorizations.
- Less time worrying about quarterly and annual audits.
In early 2024, Tampa General is embarking on the below growth strategy to expand its outpatient footprint. You can't expand market share, your outpatient book of business, in a capital-efficient manner without a better, faster credentialing process. While it's costly to set up, it's even costlier to avoid where credentialing is headed. |
Stated simply, removing the traditional credentialing bottleneck is the problem Medallion solves providing a platform for Tampa General to use post-delegation to credential providers and realize this level of success. Why haven't all large healthcare organizations set up delegated credentialing? What's holding them back? The answer is sad, but simple: it's a tough, arduous process to set up, upfront. Gathering the right documentation, and owning the credentialing process yourself, takes time. Those first few payor audits are scary. But once the foundation is laid, your process gets streamlined and efficient. Quarterly and semi-annual audits are a breeze. Cost per audit goes down as processes standardize. Your visibility into provider recruitment gets much clearer, so you have a fuller picture of any malpractice cases or other things to be aware of. Both initially and in the long run, delegated credentialing pays for itself, and there's nothing to be afraid of if you embark on that journey with a partner like Medallion. |
Delegated Credentialing is the Future, and Medallion is at the Forefront |
Bottom line: The future healthcare is headed toward - and what TGH is after - a community-based, convenient patient care model based in ambulatory environments, bolstered by a strong inpatient operation. Delegated credentialing is one significant step health systems and large practices need to think about from a growth and transformation perspective. Don't let some dumb, cumbersome administrative task get in the way of your strategic objectives to provide good healthcare to your population at scale. |
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Thanks for the read! Let me know what you thought by replying back to this email. — Blake |
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