Transcript for "Healthcare CLM platform tour: better contracts faster":
Okay. Welcome everyone to the Agiloft and Epiq Healthcare Platform Tour. I'm excited to be your host today. My name is Bryan Kowalski. This is a topic that I am deeply passionate about. To give you a bit of a background about my my experience, I started contracting provider contracting at Blue Cross Blue Shield of Michigan. We built a Medicare Advantage PPO network from the ground up. Our goal at that time was to replicate 80% of our commercial network, which meant contracting over 30,000 providers. It was a pretty massive undertaking, required a lot of detailed market analysis, planning, and execution, all before CLM was even a consideration at that time. We were a small but scrappy team that tracked everything in an access database. We leveraged facets, CAQH, Visual Cactus to verify provider information, and also monitor network adequacy through through Quest. I then moved on to BlueCare Network where I became the product owner of the CLM platform and gained really a deeper appreciation for how automation and standardization could really transform our processes. And later at WellCare, I led I led a national CLM implementation across more than 30 states, where we standardized hundreds of agreement permutations, created scalable workflows, and trained users across numerous markets. That experience really underscored for me how critical CLM is to achieving operational scale, consistency, and compliance in health care. So with that said, let me set the stage real quickly. Provider contracting is not just operational. It's really how we fuel growth, ensure compliance, and cut cost, and enable value based care. Despite the potential, provider contracting often remains highly manual, relying heavily on institutional knowledge and time consuming collaboration. This manual approach increases risk around miscommunications, compliance gaps, potential missed deadlines. It also limits the visibility into the contract status, which inevitably leads to inefficiencies that can significantly impact the bottom line and the quality of our provider networks. To deliver on strategic priorities, we really need a future state contracting platform that not only standardizes core capabilities, that also allows us to automate routine processes, streamline contract creation and amendments, and gain critical visibility across the entire provider network, but also be able to leverage AI for risk review, redline, contract analysis, as well as an integration hub that ensures full end to end life cycle data consistency and automation. This is where Agiloft CLM platform combined with Epiq's healthcare specific experience fundamentally transforms contracting. Our extensive health care experience helps not only tailor, it helps implement these solutions efficiently, maximizing the value from day one. So with that said, let's jump into the the demo here. So what we're showcasing here is our dashboard within Agiloft. And I'm viewing this from the persona of a network specialist. So is what we can do within the Agiloft platform is really be able to slice and dice our our data in a number of different ways. We can have drill down reports. I'm able to see below here all the contracts that are assigned to me, any contracts that are pending review and approval. And as you can see as we go down deeper here, again, we can drill down into a number of different areas, all revolving around your your provider data and your contracting data. So to get the contracting process start started, I'm gonna click on contracts. And as part of this, I'm gonna create a new contract here. So this takes me to my intake form. So as a network specialist, I'm gonna be contracting with the provider. I'm able to simply click and search for my the provider that I'd like to contract with, and it pulls all the information in, and a meta and the master data can be stored within Agiloft, or we can integrate with your master data source of truth. And I'm gonna populate a couple other required fields here. The renewal type, the provider type, I'm a select practitioner group, will include a delegated function, an employed physician, preferred pricing. And then below here, we'll get to some dynamic questions. So our health plan entity, we'll consider what we'll take into consideration here is that we're a multi state plan. So we can look up a number of different, entities within our our health plan. So first, I'll select Epiq Healthcare of New York. And you could see here the lines of business populate below based on the entity that I selected. Now if I go back and choose Texas, You can see their conditional logic here presents a subset of those original lines of business here, and I can simply select the lines of business that I wanna include as part of my agreement, Medicare, Medicaid. And below here, I can select my compensation type for each line of business. So I can select fee for service here for Medicare and capitation for Medicaid, and I'm presented with default options or a preferred, percent of of Medicaid and Medicare, I can change this as an end user as well. For this example here, I'm just going to stick with Medicare Advantage, and I'll also include an incentive program here, some upside bonus and shared risk. So based on this, I can now simply start generating my draft of my agreement. So it's taking into consideration the provider type that we selected, the line of business, the compensation, and the solution is building out the contract for me. So really allowing us to have good compliance, around our agreements that is automating the inclusion of that language, as part of that process. I'm gonna quickly quickly click back to the details here. So I had a very limited intake form, as part of that. But you can see here as I scroll down, I'm tracking a host of other attributes relative to this agreement that are all embedded within the actual document itself that we've generated. So going back here, I have my first version of the contract. I'm able to email it directly to the provider from the the system here. I can just simply select the contact that I'd like to send it to, and I'm able to send it out to the provider. For sake of time here, I'm gonna open up the agreement as if I'm the provider and make some red lines. So I'm gonna make some pretty impactful red lines as part of this process. I'm gonna change some credentialing language here. And you could see here that I changed this that I should only be I shall only be credentialed every five years. I'll come down as well and change some of the compensation to say that instead of a 100%, we're gonna change this here to a 107%. And normally, as the provider, I would email this back. The network specialist would receive this document, and it would be automatically adjusted into Agiloft, through through the email notification. For this example here, I'm just gonna manually upload it here, which is another path you can take. And and I'm gonna attach the agreement. And as part of this process, as we're reconciling this red line version against the original burden, the solution is looking at any clauses that are that have been created as part of this document in comparing the red lines to the original version. So once it's fully uploaded here, any clause that I do have defined within this agreement will be presented and will show any red lines. So we'll show the current markup versus the red line view as well. So that right within the user interface, I'm able to see, the various red lines that have been made or been made to the document and any changes that have been made here. So this is just taking a second as it's scanning through that entire document. It's roughly 30 pages here. And now that it's complete, you can see below here, here's my current clause text. Here's the current markup. And if I were to click into this, I can see below here, there's that change, that red line that I made to the compensation for my Medicare fee. So back in the persona of the network specialist, now that I've received a red line version, let's use some AI to be able to analyze any changes that have been made to the document. So one once again, we'll open up the document and we're gonna leverage screens AI, which is Agiloft's, GenAI module to do some analysis and risk review around this document. So up here, I have a word plug in to open screens. And as part of this just quickly sign in here. I have a screen created specifically for our payer provider scenarios. And what a screen essentially is, is it's our standard rules and prompts that we've created, so that when we do have a red line agreement, we can compare that red line agreement to our standards. And as part of this, we can categorize risk that we've associated with any of our standards to high, medium, low, so that we can quickly identify where red lines exist with exist within the agreement and where inevitably risk exists within the agreement. So as this as we're going through the the JennyI is doing those comparisons against our standards, let me query the contract to say, what is our termination notice period? And this is where we can also leverage screens to quickly be able to identify queries and and prompts that we have relative to the agreement, and you can see it brings back the same exact language that it that appears in the agreement. Tells me our termination notice period is ninety days prior. Let me just check back here. My screen's completed. And you can see here, these are all the prompts and rules that I've created relative to this specific agreement. And as part of this, you can see that it's categorized into high, medium, and low. And you can see here some have failed, some have passed our our standards. So if I just look at those that have failed as part of this, and let me jump to the credentialing requirements, it picked up that change to our credentialing requirements. So as part of this, I can simply just quick click a button, and it is going to do some surgical redlining, meaning screens and the Gen AI is gonna do surgical redlining to that redline from the provider to make it now back to our standard position based on the details that we have configured, relative to to this scenario. So you can see here that the the red line has been made and it's now back in accordance with our regulatory requirements. So I can once again save this back to the record, And now I'm ready to take the next step here. So now that we've imported the agreement and uploaded the the red line agreement, leverage screens to do some risk initial risk review of that agreement, I'm now going to initiate a further risk review process. So what we consider here a PADU process. So as part of this, it's going to build out a risk review workflow and trigger notifications to different, reviewers of this this document. So as part of this, once it's complete, each reviewer or group, that will be reviewing the the document will receive a notification, and they'll be able to do their analysis around risk relative to the agreement. So you can see here under my risk assessment, I can see the different teams that this document was sent to, for a risk review. So now I'm gonna go back to my home page here, and I'm gonna flip personas. So I'm gonna change my persona here to, one of the risk review teams. And as part of this, I have this pending task here, that I can see where I'm pending any task related to risk reviews for specific agreements. And as part of this, like I mentioned, each each of these groups will receive a notification that they have a risk review pending, and they can go into the actual task, and they're able to access the document directly from the task. And once they've completed their risk review, I can then come in here and complete and finalize the review. So from a contract management team, I'll mark this as preferred and mark my review as complete. From a network operations, I'll say this is discouraged. Mark this is complete. And from finance perspective, we'll say this is acceptable. And now once again, I'm a change my persona back to the network specialist. And as the network specialist, once my risk review is complete, I will receive once again a notification. And I can see here the status for the agreement that I was working on, the review is complete. And when I actually go into the record as well, you can see my status bar up above here, review complete. And if I go to my risk review tab, there's all the historical data, related to that risk review. And I can see now up above, I have a new button available here that says create approvals. So once again, I've completed the intake process, we generated the agreement, we send it out to the provider, the provider redlined the agreement, we analyzed it leveraging AI against our standards, we sent it through an initial risk review, preferred acceptable, discourage unacceptable process or PADU. And now I have an approval process that will be built out for me based on the the risk review, values that have been provided. So you can see below here, making this as literal as possible here, for any acceptable value, it needs to go to the network VP for, for approval. Since so we did have some discouraged values as well as part of that risk review process, it needs to go to the plan president, CEO, or c COO as part of our approval process. In all approvals, approvers will receive a notification as part of this, and included in their notification, they'll will, they'll receive an executive summary. So this gives really all the details relative to the agreement. And if I do have any red line clauses, you'll we can also embed the red line language right within the the notification. So the approver doesn't have to physically open up the document to figure out where there has been where changes have been made. They can see all the details directly from the executive summary within the, email notification. So to fast track things here a bit, I'm going to act as the approver and update the status to approved here, and save this. And you'll see that this is a sequential approval process. So my plan president will now receive that same notification, and the same executive summary that outlines all the details relative to the agreement, and any changes that have been made to the agreement as well in terms of language. So once again here, I'll mark this as approved, And I'll just click save up above, and we'll see our status bar up above has now updated to approved. So at this stage, I can now send the agreement out to our external party for signature. We can do that all seamlessly right through Agiloft. We can integrate with with DocuSign directly or Adobe sign as well. And I'm able to select here who I'd like to send it to for signature. We can also set up, delegation of authority or signature authority for signature as well, so we can automate this based on certain conditions, within the agreement as well. So as part of this, I'll just select to attach my agreement, and I'll create my DocuSign envelope as part of this. And I can again, I can send this directly from the solution, so I never have to lead Agiloft. I don't have to embed tags within DocuSign. All of that is done through the implementation as part of the configuration process. So from an end user standpoint, from a network specialist standpoint, this is a very seamless operation and how we send the agreement out for signature. And as part of this, we'll receive the signature of envelopes via email. And then once the agreement is fully signed, it will be saved, within our repository. So that completes our end to end workflow for our our our participating provider agreement. So once again, we're able to quickly go through an intake process to generate an agreement and based on the the different, factors within that intake process including the provider type, the line of business, the state, the compensation types, The system created the the correct document for us. We leveraged AI to do some review. We sent it through a rigorous internal risk review process, as well as an approval process, and got the agreement signed. Something else I wanna demonstrate for you today is taking a look at a more complex scenario, which is hospital contracting. And as part of this, hospital contracting gets into some pretty challenging scenarios where we can be contracting with multiple entities or multiple hospitals within one agreement. That agreement can span across a number of different years, one to three years for instance, and there's a number of variables as part of that, including very complex rate tables. So this is where you really start seeing the power of Agiloft where a a number of other solute CLM solutions can really not provide the same type of experience, and be able to accommodate this type of complexity within the workflow. So a similar intake process, I'm gonna select our our health plan entity here. And below here, I'm gonna select the hospitals that I'd like to contract with. So again, trying to be as literal as possible here. This will be our hospital a. I'll say that this agreement does include more than one hospital. And as part of this, I'll select hospital b here and hospital c. And now as part of this example or this scenario, for each hospital, we're going to have a different rate exhibit. So I'll select our starting point to create our rate exhibits, and based on this, it will build out the line item rate exhibits or tables that will be embedded within our documents. And you'll see here, this is now our starting point for for our agreement. So this is the table that will be embedded within the the document and specifically with within our rate exhibit. And as a network specialist negotiating a hospital agreement, I can come in here and in in real terms, I would populate all the different rates. I'd select my reimbursement type for the various rates, and I'd build out this table, in totality. And I can update this here. And now you can see I can do the same for hospital b and hospital c for year one. So as part of this process, I can negotiate the first year with each hospital and then leverage what's been negotiated, in terms of those line items within my rate exhibit to then make a copy of that for years two and three and update the rates. So fairly complex scenario, that we'll see here. So initially, I wanna generate the first year for each of those, for each of those hospitals for each rate exhibit, and this is what I'll send to my, third party for review, and this is where we'll begin the negotiation and changing of some of those line items within the rate exhibits. And it can be dynamic. What happens for hospital a does not need to be the same for hospital b. And as part of this process, I want my base agreement to be a stand alone document and I want each of the hospital rate exhibits to also be a stand alone document. So you can see here how we built this out. There is your rate exhibit embedded based on that table that we just showed as part of the intake process. So as part of the negotiation, I can come back to my rate exhibits and I have the ability through the UI to select where I want to add or change certain line items within that rate exhibit. So I can simply select the fallback or an addition, to add a line item here, and it will update the table dynamically. Once that's complete, and I can update the rate exhibit there. If I wanted to add additional carve outs or in this case some stop loss language, as well as some outpatient exclusion. We can configure this so you can do this all through the UI versus having to scan through the entire document and manually make clause changes within the agreement. So as part of this process now, I can then look at creating based on year one. I can now replicate those tables that we've negotiated for year one, for year two, and build out the same tables that have been negotiated, rate exhibits that have been negotiated for year two, and then dynamically update the rates associated within those tables. And we can see here below, here's year two for hospital a, year two for hospital b, and year two for hospital c. And once again, I have the ability to go in here and change and update these rates based on the originally negotiated year one and generate my year two exhibits. And this is now creating those stand alone attachments for year two. And we would essentially do the same exact thing for year three. So as part of this, we have nine different rate exhibits along with our base document as well. So a package of 10 different documents included as part of this that we have negotiated, stand alone here, and allows us to have a really dynamic yet complex, scenario and be able to solution for that within Agiloft. So that really demonstrates two very common scenarios. One on more of our typical participating provider end where we're contracting with a doc, as part of that scenario, and then a very complex scenario where we're looking at a hospital agreement that includes three different hospitals across three years, and we have to dynamically be able to negotiate each of those, rate exhibits for each independent hospital. So at this stage, I will take a look if we have any questions that I can help address. Okay. Well, I just wanna thank you all for taking the time to spend with us today and go through our our health care solution here as it relates to Agiloft and Epiq, and we look forward to hearing from you in the near future. Thank you all for attending.