ARNG Centralized Clinical Credentialing & Provider Management


Summary

The Army National Guard (ARNG) is the first force component to leverage public/private partnerships, leading technology solutions, and world-class customer service for the centralized credentialing and provider management process. The ARNG’s centralized credentialing project has standardized the quality of credentials information for ARNG providers, improved soldier readiness, enhanced visibility of aggregate force capabilities for command-level decision making, realized a positive ROI within four years, and is currently projected to be $455,000 under budget at the conclusion of the current contract phase. The project has been completed on time and on or under budget at every step. This highly scalable model is applicable for use across all force components of the military.

Project Overview

In June 2006, the Army National Guard (ARNG) Chief Surgeon’s Office began working with a management consulting firm (Tenon Consulting) to design and implement a centralized clinical credentialing capability for its approximately 1,500 privileged providers. The ARNG sought to improve the readiness and mobility of these providers while assuring the clinical competency of these individuals in order to provide the highest level of care to our fighting forces. The resulting capability, as designed and implemented, is a scalable solution leveraging collaborative public/private partnerships, proven commercial technology, and industry best practices to modernize the credentialing process.

Prior to centralization, credentialing was conducted independently in each of the 54 states and territories as a paper-based process with local procedures, resulting in varying degrees of credentials quality and readiness. The individuals assigned to complete the credentialing tasks often had minimal credentials training and completed this work as an additional duty. Collection and storage of copies of credentials documentation often resulted in lost information and redundant effort to collect additional copies of the documentation in support of subsequent credentialing episodes, thus often impeding the mobilization process.

As part of the centralized credentialing initiative, the ARNG has established partnerships with several private-sector credentialing industry leaders to drive efficiency. First, the team is leveraging the Council for Affordable Quality Healthcare (CAQH) electronic credentials application. This application is currently utilized by over 1,000,000 providers who submit credentials information once through a single interface and provide visibility of that information to multiple credentialing entities including hospitals and insurance companies, and now the ARNG. Leveraging CAQH dramatically minimizes the credentialing burden on providers and simplifies meeting their ARNG credentialing requirements.

In addition, a dedicated team of experienced credentialing professionals at Military Credentialing Solutions (MCS) works with the states and providers to collect all existing credentials documentation, review and analyze that information, and scan it into an electronic format for ongoing management. MCS then conducts the prime source verification of each required data element. Once all the credentials and verification information has been collected, this information is organized into an electronic credentials file conforming to the standards set forth in AR 40-68. The MCS staff reviews each file to ensure all risk management issues have been fully identified and investigated and that the quality of the file meets or exceeds Army standards. This file review includes real-time monitoring of sanctions information reported from over 400 sanctions sources nationwide. This program represents the first time this information has been actively monitored by the ARNG.

The electronic file is then submitted for review to a Credentials Certification Board (CCB) which meets three times per year, composed of ARNG State Surgeons, and Military Treatment Facility (MTF) and MEDCOM representatives, who verify the provider’s fitness for clinical duty. Upon CCB approval, the file is uploaded in its entirety into the DoD credentials system, CCQAS, where it is perpetually maintained to support privileging actions. The MCS team has also assumed responsibility for generating Interfacitlity Credentials Transfer Briefs (ICTBs) for all centrally credentialed ARNG providers, and provides online tracking of all requested and in-process ICTBs to state, national, and MTF leadership.

To date, the team has achieved a 98+% CCB approval rate for files presented, and has received outstanding customer satisfaction marks from MTFs receiving ARNG ICTBs based on quality, reliability, and timeliness. This centralized credentialing program allows providers, ARNG leadership, MTFs, and privileging authorities real-time visibility of provider credentials. This process has leveraged experienced personnel, streamlined processes, and cutting-edge technology to significantly improve the quality, visibility, and scalability of the credentialing process throughout the ARNG. We are currently expanding this capability to include credentialing for new ARNG accessions, and are exploring how this solution can be implemented to support other force components.

Savings Analysis

This project is being completed on a firm, fixed price basis. Each phase and milestone of the project has been completed on time and on or under budget to date under the guidance of the ARNG Chief Surgeon’s Office. By leveraging industry-leading private sector partners, the ARNG has achieved significant financial savings over the project life cycle while realizing a positive return on investment (ROI) in less than four years, as depicted in the chart above. Projected costs and ROI through FY15 are also included in the chart. In addition to the cost savings, by outsourcing a portion of the credentials work and centralizing the remainder to a small, dedicated team of credentialing professionals, the ARNG has returned approximately 40 full-time-equivalent (FTE) clinical officers to their primary state-based duties including training, scheduling, recruiting, and privileging activities. This number was derived through analysis of the decentralized model wherein .75 FTEs per state/territory were estimated to perform credentialing duties (.75 x 54 = 40.5). In addition, the program is currently projected to be over $455,000 under budget, including labor cost reductions and travel savings, through the end of Option Year 4 of the current contract phase.

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