Lowering the cost to collect, while improving data transparency

Englewood Health, based in Englewood, New Jersey in Bergen County, is one of New Jersey’s leading hospitals and healthcare networks. Composed of Englewood Hospital, the Englewood Health Physician Network and the Englewood Health Foundation, its health system delivers nationally recognized care in a community setting to residents of northern New Jersey and beyond.

The Englewood Health Physician Network (EHPN) was formed in 2011 with a small nucleus of physicians. They began to expand by bringing successful, strategic-minded providers to the group. In addition, they knew it was critical to identify the right business and technology partners in order to sustain and bolster their growth.

Englewood’s partnership with CaduceusHealth and athenahealth has resulted in successful expansion. Between 2011 and 2020, Englewood Health grew from a $30 million to a $120 million operation, and from 50 to over 500 providers, using athenahealth and CaduceusHealth revenue cycle management services and technology.

The right partners streamline and strengthen revenue cycle management

In order to be successful, EHPN needed a robust revenue cycle management system. Unsatisfied with their vendor, EHPN began the search for a managed service organization (MSO) that could offer standardization, transparency into performance, and improved collections.

athenahealth and CaduceusHealth were the right choice for EHPN because their combined solution offers robust collections capabilities and emphasizes data transparency. “Revenue cycle management is the lifeblood of every practice,” says Michael Pietrowicz, Senior Vice President and Chief Strategy Officer for Englewood Health. “That is the core strength of athenahealth and CaduceusHealth.”

CaduceusHealth and athenahealth support much of the technical and administrative work so networks like Englewood Health can focus on patient care. The athenaCollector revenue cycle management solution offers easy remote management and user-friendly interfaces for real-time insight into performance across the network. CaduceusHealth and athenahealth also automate administrative workflows, which allows for faster onboarding of new practices and scalable growth.

One key to Englewood’s success is the fact that revenue cycle management is integrated across inpatient and ambulatory locations. Even though outpatient practices use athenaCollector and the hospital uses Epic, administrators can work across locations to help resolve claim holds and denials. “We’re able to look across the network in order to optimize operations,” says Pietrowicz.

Deep insight into performance aids front line clinicians, guides leadership

Before the partnership with athenahealth and Caduceus, the group lacked real-time visibility into its own financial data. Englewood relied on retrospective month-end reports to get a sense of its performance.

Now, standardized data allows athenahealth and Caduceus to develop analytics programs that can be used across locations, saving valuable time. “Our partnership with athena and Caduceus gives EHPN leadership, providers and staff rich and timely information,” says Stephen Brunnquell, M.D., President, Englewood Health Physician Network. “We can assess daily operations and monthly trends, and pinpoint areas that need optimization.”

As a physician-governed organization, it’s important to Englewood Health that their revenue cycle management is user-friendly to clinicians on the front lines as well as those in leadership positions. “Our doctors are pleased that they have 24/7, 365 access to revenue performance information,” says Brunnquell. “They trust the system.” Physician leaders appreciate how easy and seamless the technology is to use and are especially pleased with bottom-line results.

Establishing strong financials is a cornerstone to growth

Another key to Englewood’s success is athenahealth’s Billing Rules Engine. The rules engine proactively scans claims in order to catch errors before they can be submitted. “We make sure that our claims are as complete and accurate as possible, which significantly reduces denials and improves first-pass resolution rates,” says Michael Kaseman, Director of Finance and Reporting, Englewood Health Physician Network.

Englewood has dramatically improved its ability to collect patient pay responsibilities. “Together with athena and Caduceus, we implemented the systems necessary to support team members on the front lines,” says Kaseman. “When patients arrive for their visit, staff have already advised them what they owe and collect the appropriate amount.”

As a result of this team effort, Englewood’s third-largest source of revenue is self-pay patient collections, behind only Medicare and Blue Cross.

Nimble systems support a rapid pivot to COVID-19 protocols

With the help of athenahealth and Caduceus, Englewood Health scaled its telehealth offerings from three to 45 service department practices in under a week. athenahealth and Caduceus also helped create Instant Custom Rules to preserve COVID-19 noninsured billing from being sent to patients, so claims could later be submitted to the CARES Act Provider Relief Fund.

“When COVID-19 hit, athenahealth and CaduceusHealth never missed a beat,” says Brunnquell. “We were able to transition to virtual care under work-from-home orders and collect regularly on new telehealth visits.” Caduceus quickly implemented a remote patient payment application, allowing text-to-pay from a patient’s phone, which fully integrated with athenahealth’s credit card processing functionality.

In fact, athenahealth and Caduceus were able to keep Englewood’s cash level stable for March and reported it was only off by about 10% in April, at the height of stay-at-home directives. As patient volume returns, Englewood is in a strong financial position because of their ability to maintain billing and revenue throughout the crisis.

A centralized approach equips the network for long-term growth and profitability

Now that Englewood Health has centralized their technology systems, they can move forward with long-term growth plans even in the constantly evolving healthcare market.

When evaluating an acquisition, athenahealth and Caduceus help Englewood Health assess the potential of a new practice and how will it complement the network. “We depend on the insight of athena and Caduceus as we pursue ventures with potentially new groups,” says Pietrowicz.

Once an acquisition has begun, 14 embedded CaduceusHealth staff members are onsite to help with onboarding new services and clinics. “They support the heavy lifting to make sure every new practice is a seamless onboard with no surprises,” says Brunnquell.

Recently, Englewood Health expanded into the urgent care market with an acquisition that coincided with the COVID-19 crisis. “We were able to bring on a new urgent care center in a fairly short timeframe,” says Pietrowicz. “athena and Caduceus helped our team develop the systems, such as accounting and charge structures, that we need for this type of setting,” says Pietrowicz.