By Roshni Patel, Customer Success Manager, Royal Ambulance
Royal Ambulance is a California-based transportation company committed to connecting patients and providers in the healthcare continuum through transportation, technology and seamless experiences. We partnered with a medical insurance network in the San Francisco Bay Area focused on providing easier access to high-quality care with cost transparency. Roshni Patel and Royal Ambulance won the 2021 SAMA Excellence Awards in the category for “SAM as the Leader.”
Identifying Customer Roadblocks
When we first established our partnership with the insurance network, Royal was just one company among many servicing the network’s network of hospitals and doctors. Our customer sought a trusted transportation provider who could help them keep patients within their provider network, ensuring quality patient care at a lower cost to the health plan. Each hour a patient spends in a non-network hospital increases the cost to the insurance network significantly.
During the initial discovery phase with the customer, our team at Royal established a regular meeting cadence with the insurance network’s director of transitional care programs, with the goals of determining current barriers to keeping patients in-network and identifying and addressing inefficiencies in transportation ordering workflow.
Specifically, we collaborated with the insurance network to develop the following list of prioritized objectives:
- Leverage transportation to ensure patients receive care within the provider network.
- Reduce the overall financial costs to the health plan when a patient obtains care out-of-network.
- Decrease the time case managers spend on scheduling patient transport.
- Create a single transportation hub for medical and non-medical transportation needs to streamline and simplify transportation requests and provide the appropriate levels of transportation for patients’ needs.
- Educate case managers on how to triage appropriately for level of transportation based on a patient’s medical condition, reducing costs to the health plan or to patients who may be responsible for paying directly for transportation services.
Streamlining Internal Process to Meet Customer Goals
Through lean process improvement analysis and value-stream mapping, we developed a process for identifying patients being registered at out-of-network hospitals and a pathway for their seamless repatriation to an in-network facility before being admitted out-of-network.
To make this happen, we:
- Aligned a large, cross-functional, cross-organizational team to map out the current process, identify roadblocks and create an ideal future state vision. Teamwork with operations and delivery teams at Royal, including billing and dispatch, was critical.
- Gained buy-in from both in-network and out-of-network hospitals throughout Northern California to change their internal process for arranging transportation. This required meeting with each hospital to better understand their priorities and how best to streamline their processes to both make their jobs more efficient and achieve the customer’s objectives.
Now, when a patient member is registered in the Emergency Department of an out-of-network hospital, the insurance network receives an alert. This triggers an action to identify the patient and assess whether it would be safe to move him or her to the nearest in-network hospital. Once the case has been reviewed by a case manager, an alert is sent to Royal to begin allocating resources for transport. Royal then contacts the in-network hospital’s Emergency Department to give an ETA for the impending admittance.
Since implementing the project, Royal has seen the following positive results:
- A dramatic reduction of costs at the insurance network – to the tune of roughly $300,000 per patient rerouted from an out-of-network hospital to an in-network one.
- Increased employee satisfaction among case managers at the insurance provider. The streamlined process reduces case manager workload, enabling them to spend more time on direct patient care. Every month, Royal’s interdisciplinary team comes together to review data from the previous month to provide insights to the insurance network about its transportation utilization and to make adjustments as necessary.
New Business Opportunities
In addition to the customer benefits above, this project has served as a launch pad for partnering with the customer to solve other strategic business problems. We have identified an opportunity to pinpoint patients with high risk for hospital readmission and provide these patients with access to home visits, medication delivery and other resources that will reduce risk of re-hospitalization. In doing so we can reduce the cost of care, improve patients’ experiences, and ease the burden on hospital resources – a critically important goal during the COVID pandemic.
What processes has your organization initiated to combat customer roadblocks?