Ask Each Role the Questions Only It Can Answer

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.