Health Plan Improves Compliance through Online Education

how Health Plan of San Mateo used Litmos Healthcare to improve compliance

We recently had the opportunity to chat with Ellen Dunn-Malhatro, the Director of Compliance and Regulatory Affairs from the Health Plan of San Mateo on how they used Litmos Healthcare to improve compliance.

This session discusses how they implemented Litmos Healthcare education, why they chose online training versus classroom training, and the impact of their training initiatives.

Below is the transcript of the webinar and conversation.

CHELSEY:
Welcome to our Virtual Client Conference. I’m so glad you’re joining us for this session with Ellen Dunn-Malhatro, the Director of Compliance and Regulatory Affairs from the Health Plan of San Mateo. During our time together, she’s going to discuss how they implemented BridgeFront’s compliance education and the resulting impact. It’s with great pleasure that we welcome Ellen.

ELLEN:
I’ve been at the Health Plan in San Mateo for going on 12 years and the Health Plan of San Mateo began in 1987 as a Medicaid managed health care plan. Since then, we’ve grown considerably and we have a Medicare Advantage special needs plan which is for our dual-eligible – those who both have Medicare and Medicaid. And if I say Medi-Cal, for those of you in other parts of the country, that is the California Medicaid program…In addition to the Medicare and Medicaid products, we also have two products for children – again, low income children and a program for some workers in the county who provide services to recipients of in-home supportive services. Those are services, again, provided to disabled residents who are living in the community. And finally, we work as a TPA for a county indigent care program. So, I hope that gives you sort of a broad idea of who we are. We are small, we have a hundred thousand lives, but I think we are a rather complex organization.

CHELSEY:
Thank you so much, Ellen. So let’s get started and get a little bit more information about what was that issue at San Mateo that resulted in you selecting BridgeFront as your education partner.

ELLEN:
Yes, when I first started back in 2000 at Health Plan of San Mateo, we had 75 employees. We changed remarkably in the time that I’ve been here. Even though we’re still small, we have 200 staff. Going from 75 to 200 presented numerous problems for me as the compliance officer. We have training requirements, both for HIPAA, as well as for CMA, which meant we had to do compliance and fraud, waste and abuse training, as well as training around Medicare. Very difficult when I began with HIPAA training with 75 employees, I would do it in a classroom situation. In some ways, it was a lot of fun. I got to see all the staff on a regular basis. But, with 200 staff and with the addition of all the other things going on with compliance, classroom training became an impossibility. And, I realized I had to look for a different kind of solution to be compliant with both the HIPAA requirements, as well as those that were coming from CMS.

CHELSEY:
So, did you have a budget for that or how did you create, perhaps, a business case to determine that I need to look outside the box and it just can’t be me standing in front of a classroom?

ELLEN:
Exactly, I didn’t have a budget. Some of the advantages of being a small organization is I have a little bit of flexibility – actually, I have quite a bit of flexibility, and I also report to the CEO. I started going basically on the internet and just started looking around at what kind of programs were available. I knew nothing about web-based programs at the time and I just started hunting around and basically that’s how we came across BridgeFront. I was looking for a company that offered the kind of courses that I needed and that did it in a way that was financially doable for a small organization.

CHELSEY:
Wonderful and what were the important key sound bites that helped you kind of pitch the concept that you needed to invest additional time and resource in delivering this education? Were there a couple things that you can share with our guests today?

ELLEN:
In my communication with my CEO?

CHELSEY:
Yes.

ELLEN:
It wasn’t all that difficult because as we’ve grown and as the issues confronting us and the time that we need to meet the regulatory requirements, she understood that my time was just really stretched and so her biggest issue for me was the financial piece of it. Could we find a company that provided us a solution that we thought was really adequate for our staff and in a way that was affordable for an organization that is? We are a government-type organization and so we don’t have a lot of extra funds. I also worked very hard with my compliance committee. There were some members of the compliance committee who helped review vendors…and they really weighed in on the fact that they just liked the way the HIPAA program was from BridgeFront and so I had the backing of first of all my compliance committee and they also weighed in on what program they liked and my CEO really understood the time frame and the commitment on my time.

CHELSEY:
Wonderful! Well that’s a great transition to solutions. So can you tell us a little bit more about what you selected from our course and product line that helped you address your issues?

ELLEN:
Absolutely. The first one that I really wanted to look at was HIPAA. As a health plan, we really have to be very concerned about how we protect the member’s information and HIPAA…and I don’t know, those of you in health care and know about HIPAA and know how serious this is becoming, and we had a small breach. I was looking for a solution that really went into the details, that would really provide staff an understanding and really emphasize the importance of HIPAA and our protection of information for our members. The second focus had to do with the ability, as I said before, to provide a compliance in fraud, waste and abuse training.

CHELSEY:
And since you have been delivering this in classroom, did you take the courses that were available from BridgeFront? Did you modify or create any of your own courses to support any of your learning objectives?

ELLEN:
To modify and create courses was one of the selling points that BridgeFront offered me. I looked at, as I said, a number of programs. None of them allowed me to go in and make changes. I must say that the HIPAA course is excellent and I had incredibly good feedback from staff. But I wanted to personalize it. I wanted people to know and to recognize me, so I wanted to be able to put up a picture of who I am and who our security officer is. I wanted to put information that was relevant to this particular agency. So I was able to, after very little training, to go in and be able to modify slides and to add some slides. This was really important to me because I felt that if I could personalize it and make it just a little bit more relevant to my agency, that it would really help them and also achieve my purpose…which really was to be able to understand how HIPAA worked in our agency. And that was the same for compliance in fraud, waste and abuse.

CHELSEY:
I know that you did that and I’m curious, Ellen, if you’d be interested in sharing with our audience what has happened since?

ELLEN:
I would really like to because one of the things that has really happened…I didn’t mean to cut you off. But it was really, very wonderful that establishing really a partnership about the kind of courses that can be offered. When I did the addition in the compliance in fraud, waste and abuse I had some conversations with staff, in fact, with Chelsey about the fact that those courses did not really meet my needs, that I had to do too much editing. That the courses weren’t focused so much on a health plan, but were focused for a different venue and I said that it would really be helpful to have courses that were more focused on a health plan for compliance and fraud, waste and abuse because of the training requirements by the centers for Medicare and Medicaid services that require health plans to provide this type of training to staff. So I will be using the HIPAA, the compliance and fraud, waste and abuse and with much less editing than I had to do because of the work that BridgeFront has done.

CHELSEY:
Well your feedback was wonderful because those courses, as they originally stood, were really built for hospitals and physician providers and other people and organizations in health care, so your feedback on the health plan really helps us to create something that was more specific and we really appreciated you giving us that feedback. Can you give us a little bit more feedback on what the positive results – all of this has had on your organization?

ELLEN:
First of all on my time, I feel a little overwhelmed by the amount of work that we’re doing at this plan so I just don’t have the time to go in and create a course, I don’t have the time to be really focused on this. I need something that will meet the needs of the agency, but there will be less need for me to be intervening. So what I was able to do, which has been a tremendous help, is I have an administrative assistant and because it’s easy to send out the courses that even though we do our annual trainings, I’m able to delegate to someone else who’s learned the system and he’s responsible for sending out on a sometimes weekly basis. I don’t worry about this at all because I know that I have someone now trained who can send it out. I am just focused on looking at the courses that are going to be done annually to the staff. I’ll take a look, as I have, the compliance, fraud, waste and abuse and I know that there’ll be some changes in the HIPAA because things are always changing with HIPAA – that will be updating the course that we use. And it just has relieved me of a responsibility that…it has just made it easy to meet my compliance obligations.

CHELSEY:
How about from tracking and documenting and reports? How did you do it before when you were delivering in a classroom and how do you do it now and effective?

ELLEN:
Yes, it was rather difficult as I’m sure others on the call probably appreciate, you have to keep sign in sheets, so you’d have to go through and you’d have to keep the sign in sheets and then there was no way to really test whether or not anyone was really understanding the information. So by going to a web-based program, first of all, you can give them a time frame for doing it and so it’s helped. The feedback I received was from the user’s standpoint, they were able to take the course at a time that was convenient for them, so not everyone from one department would be taking it at the same time. They could also, as the HIPAA module has three different pieces, they could take one and then wait and take the other one the following day or the following week so there was a little more flexibility in terms of the staff time and so that was one thing. I no longer had to keep anything in paper. Everything is documented, so if I get documented by OCR – the Office of Civil Rights who comes into my organization, I can easily show them when people took the course and that they all passed a post test and that’s a very important thingbecause I heard the feedback was from many people, “gee, I really had to read those questions.” “I didn’t really pass the first time. I had to go back and really spend some time on this.” And I think with the web solution, where they have to take a post test, I just thinks it’s a better solution than what I was able to offer.

CHELSEY:
I think you made a good point from the standpoint that not everybody gets it the first time, right?

ELLEN:
Well yes, and I did a couple of things. One is I engaged my compliance committee. So I have a compliance committee, we meet very regularly – basically eight to nine times a year. We had discussions about this, so I had the buy in initially from my compliance committee and my committee has a lot of senior staff, so by having my senior staff – my colleagues on board, that already gives me buy in at that level. And I asked the managers to talk in their meetings to prepare the staff for the fact that they would be receiving this. So there was a bit of a roll out. I was surprised, I had absolutely no negative feedback from anyone and the only feedback I got was very positive, frankly.

CHELSEY:
Well it sounds like you did a really great job engaging everybody from the top down to the middle managements to really help you kind of extend this out to your audience.

CHELSEY:
Ellen, is there anything else that you’d like to share with regard to maybe the results, the outcomes? How does your CEO feel today?

ELLEN:
I think, again, because we’re small and we have the same obligations that any health plan does, so in the state of California, I have to report to the Department of Managed Health Care, well so does Aetna’s and so does Kaiser, so we’re under the same compliance requirements of any health plan, even though we’re a small plan. So what I say is I need to work more smartly because I can’t keep adding staff, there’s a limit to how many staff one can have, so one has to find other solutions to meet the compliance and regulatory requirements that we have. So I think that’s really the key in what I do in looking for solutions.

CHELSEY:
Is there anything else you’d like to share?

ELLEN:
The three courses that I’ve mentioned and the other one – I will probably be looking at Medicare trainings cause we do have to do that, so I’ll probably take another look at the Medicare trainings that you have and we might expand beyond the three that I’ve already mentioned that we’ll be doing to maybe a fourth one, cause that’s also a requirement since we have the Medicare Advantage Program and we keep expanding in staff and I think we need to put something together, so that would be my next move.

CHELSEY:
Wonderful. Well Ellen, thank you so much for joining us this afternoon. We really appreciate it. Your story is a great one to tell and we really appreciate having you as a client because you do great things and you’re awfully fun to work with. Everyone have a great day. Thank you so much.