A Mature Between-Visit Operation Can Answer Every Question by Program

A mature between-visit care operation can answer every question below, program by program. Any “we don’t know” is a to-do item, not a failure; the failure is not knowing that you don’t know.

Finding patients:

• Can we produce the list of eligible patients for each program on demand, from data, not memory?
• Do we know which payer each patient has, and whether that payer pays for this service?
• Does someone own working the list every week?

Enrolling honestly:

• Does every enrolled patient have a documented consent that says what they agreed to and what it may cost them?
• Can the staff member who enrolls patients explain the program in two minutes without a script?
• Does every enrolled patient have a care plan they’ve seen?

Doing the work:

• Does each staff member start the day with a queue of who needs them, instead of building it?
• Do we know which patients got no contact this month before the month ends?
• Does every escalation reach a clinician within our own stated deadline?

Recording and collecting:

• Is time or activity captured by the system as work happens, not reconstructed afterward?
• Does every claim pass a pre-claim check against the program’s requirements?
• Do we know our denial rate by reason, and is it falling?

Checking whether it helps:

• Did we choose a clinical measure before launch, and do we review it monthly?
• Do we ask patients whether the program helps them?
• Have we ever stopped a service because it wasn’t helping?

Lasting:

• Could the program run for a month without its most important person?
• Do we know what the program costs per enrolled patient-month, including admin minutes?
• When the rules change next January, who reads them and who decides what we change?

The group with the most “we don’t know” answers is the step of the Attention Loop to work on next.