Cow Creek Health and Wellness Center: Taking control of practice financial health
Southern Oregon’s Cow Creek Health and Wellness Center serves both Native American and non-native populations at its two clinic locations. A Primary are Home Clinic, its spectrum of providers includes physicians, mid-levels, dietitians, behavioral health therapists, adult and child/adolescent psychiatrists, pediatricians, and a podiatrist.
Serving native populations comes with unique technology challenges. “We have to make sure that all of our data remains on tribal lands and within our control,” said Dennis Eberhardt, Cow Creek’s clinic director. “Consequently, our processes can sometimes be more cumbersome. We also have unique obligations for reporting to the Indian Health Service (IHS) and for claims to Medicaid and Medicare.” Most care through the clinic is at no cost to American Indian/Alaskan Natives, but some is not. “It can get very complicated,” Eberhardt said.
Exchanging knowledge and growing a partnership
From a management standpoint, the practice needed better visibility into its financial performance. The in-house billing team handled the growing complexity of medical billing and coding rather well. However, the practice lacked consistent, actionable data to improve decision-making. It also never had a high level of trust that the system was performing as it should and providing optimal results.
There were also billing complications due to Cow Creek’s status as a tribal health organization. “Tribal billing in Oregon for Medicaid is complicated,” Eberhardt said. “Our Medicaid managed care environment doesn’t often respect federal protections for American Indians and Alaskan Natives. The state’s system can’t manage the complexity. Consequently much of the Medicaid managed care billing had to be done on a spreadsheet. With the previous system, it had to be a manual-entry process.”
“These improvements show that something is working in this system that wasn’t working before.”
Dennis Eberhardt, Clinic Director, Cow Creek Health and Wellness Center
That’s why soon after implementing Greenway’s EHR and practice management solution, Cow Creek implemented Greenway Revenue Services for revenue cycle management. “The onboarding process was very smooth,” Eberhardt said. “Their implementation team managed it professionally and adroitly and the handoff to operations was seamless.”
The implementation process created a true, learning partnership between the entities. “Prior to coming on board,” Eberhardt said, “the Greenway Revenue Services team did not have a lot of experience with tribal entities but had a tremendous amount of experience with revenue cycle management.” As the two teams partnered, they learned from each other — Greenway provided knowledge transfer to the Cow Creek team regarding claims and billing processes, while the Cow Creek team taught Greenway about the intricacies of tribal health practice and accounting. A lasting partnership was forged.
Cow Creek has seen major improvements since implementing Greenway Revenue Services. “The impact on our operation was immediate,” Eberhardt said. “From an administrative standpoint, the easy access to accurate data is phenomenal, and our Greenway Revenue Services team continually finds areas that we could improve upon.”
The practice now has the tools to make informed, data-driven decisions. Practice key performance indicators have improved dramatically. Cow Creek has decreased its charge posting lag from date-of-service to about two days. This could potentially reduce time to payment by a week. The clean claim rate is now a healthy 89-90%, while days in A/R are down to 29. Zero-60 aging stands at 93%. Cow Creek is now touching MGMA benchmark ranges in all three categories. “On a global scale,” Eberhardt said, “these improvements show that something is working in this system that wasn’t working before.”
Clean claim rate: 89-90%
0-60 aging: 93%
Days in A/R: 29
Not as vendor, but as part of your team
The addition of Greenway Revenue Services has even allowed Cow Creek to shift billing team duties from daily hands-on functions to more monitoring and managerial tasks, meaning they’re focused on higher-value work. “Our staffs are quite pleased with where this is going,” Eberhardt said, “and feel that overall, it’s raised the level of professionalism. For my part, I feel like I’m in control of the fate of the clinic financially as much as one can be.”
The practice maintains its close ties to its Greenway Revenue Services counterparts. “I’m really pleased with them,” Eberhardt said. “I feel they’re not a vendor but part of our team. It’s the fact that they understand us. If something unique happens or we need to change a process, they don’t approach it like a vendor providing a service, but in the spirit of pitching in to complete the task as if they were one of my employees.”
Through partnerships with Greenway Health in EHR, practice management, and revenue cycle management, Cow Creek has positioned itself for both clinical and financial health. Eberhardt and his colleagues appreciate the importance of both.