Ask Each Role the Questions Only It Can Answer

Role-by-Role Field Questions

Each role in a between-visit program sees a different part of it. These questions are for the weekly or monthly conversation with each person, and for the person asking themselves. A good answer is specific: a number, a patient count, a step in the process.

For the physician owner or medical director

Which programs are we running, and which one would I stop tomorrow if I had to?
How many minutes of my time did the programs take last month, and were they spent on decisions only I can make?
What is our Capture Ladder for each program, and which rung loses the most patients?
Do I know what a patient is told when we enroll them, including what it costs them?
Did any program help patients last month, by the measure we chose before launch?
If Janelle (or whoever holds our program together) left next month, what would break?

For the practice administrator or COO

What is our contribution margin per enrolled patient-month, by program, at our real collection rate?
What are our admin minutes per patient-month, and what took the most of them?
Which step still lives in a spreadsheet or in one person’s memory?
Which Medicare Advantage plans pay for these services, and which don’t, and do our schedulers know?
Are we staffed to the work, or to the enrollment target?

For the care-management lead

How many enrolled patients got no contact last month, and why?
Which escalations waited longer than they should have?
How much of my team’s day went to finding work versus doing it?
What’s the one task I’d hand to software first?
Which patients are in a program that isn’t helping them?

For the care coordinator or medical assistant

How do I know, when I sit down in the morning, who needs me today?
Which calls do I make that nobody records?
What question from patients about the program can I not answer well?
What do I do by hand that I do the same way every time?

For the billing or revenue-cycle lead

What share of our denials trace to a missing consent, care plan, or time record?
How many served patients never got billed, and where did the record fail?
Are we billing any combination of services in the same month that the rules don’t allow?
How many days after the service month do claims go out?

For the health-system ambulatory leader

Is our care-management function close to the patients, or in a building across town?
Do our sites measure the same program the same way?
Which site gets the best results, and have we studied why before telling the others to copy it?
Does the central team cost more than it collects, and if so, is it buying outcomes that justify it?

For the ACO or value-based-care leader

Which of our practices bill the care-management services they already deliver?
Are we paying for care management inside the ACO that practices could bill themselves?
Which program shows up in our utilization data, and which one only shows up in revenue?

For the digital-health founder

Which rung of the Capture Ladder does my product move, and how do I prove it?
How many admin minutes per patient-month does my product remove, measured at a real practice?
Is my price a share of the practice’s reimbursement, and what happens to my business when the rules change?
Which link of the Clinical-to-Cash Chain in Doing the Right Thing Is Not a Business Model is my customer actually missing?

The overlap between roles is deliberate. When the physician owner, the administrator, and the care-management lead give different answers to the same question about the same program, the disagreement is the finding.