The weakest link in financial and clinical communications involves voice and telephone conversations. They aren’t documented or retrievable, leaving insurance companies free to claim payment misunderstandings or Joint Commission to deem information hand-offs as insufficient. The White Stone Group of Knoxville, Tennessee focuses on capturing and managing those “communications events” that drive reimbursement and patient care. We spoke to CEO and CTO Guille Cruze about the company’s TRACE and OptiVox products and the benefits customers are seeing from their use.

Give me some background on The White Stone Group.

I founded The White Stone Group in 1991. I was a developer/programmer for about 12 years prior, back in the eighties. By the early nineties, I decided I wanted to do something different.

The White Stone Group was launched and operated as a sole proprietorship for the first six years of its existence. My clients were primarily physician practices who didn’t have time to understand the myriad of nuances inherent in the computer industry. I would act on behalf of the physician, striking what I considered to be a good deal for both the computer vendor and doctor’s practice. All the while, I was still writing a little bit of code for some of my other clients.

It was in the physicians’ environment that I discovered the issues surrounding the then-current pre-certification process. Nurses and other healthcare associates were waiting for many minutes and sometimes hours on the phone for insurance companies to give their blessing for a particular procedure.

I wrote a solution in 1997 called VoiCert that telephonically automated the pre-certification process for healthcare employees. The launch of VoiCert was a classic American story. Everything I owned was mortgaged on a simple but elegant solution.

After hundreds of installations, VoiCert later gave birth to our existing products, TRACE and OptiVox. Those were the beginnings of what now is home to about 80 people here at The White Stone Group.

Let’s say I’m a hospital running Cerner, Meditech, or Epic. Why do I need TRACE?

Someone interested in a more efficient and effective way of being reimbursed for services rendered would need TRACE because there’s a tremendous amount of dollars that fall through the cracks in different forms.

First and foremost, there’s a plethora of denial dollars. The evidence you’re going to need as a hospital to reclaim or be reimbursed for services rendered will often be embedded in what we call communication events.

For example, a hospital calls a payer and provides the details for an authorization regarding a patient’s procedure. The information is processed by the payer and the hospital staff person is given an authorization number, like “1234″. The employee might accidentally transpose the authorization digits as “1324″ when entering it into their HIS system. Or, the payer may state you never called for an authorization.

This creates an iterative process by the payers requiring evidence and proof. At some point, many claims are simply not worth it. Subsequently, you don’t get paid.

That’s the value of having a recording of the insurance company stating the authorization number of “1234.” The evidence is embedded in the call record. It’s not only proof, but truth.

TRACE allows for the capture of all these communication events that occur across different mediums like phone, fax, paper, and Web sites, at different times, from different people. TRACE doesn’t create the communication events, but captures them so you can easily retrieve the information that’s contained inside and use it to manage denials, improve workflow, and increase productivity.

Walk me through what a typical user would do with and without TRACE.

TRACE captures and stores all of the images, faxes and phone calls your patient access or case management team has generated. As Patient Financial Services begins working its denials, TRACE places at their fingertips the content of any and every communication event that was completed.

When the payer says “you didn’t get an authorization,” TRACE gives you the ability to say, “I have your people saying it’s’1234′. Do you want to hear it?”

It’s been shown that having the proof readily available will get insurance companies to adjudicate the claim faster. Many claims of $1,200 or less are getting swept under the rug. TRACE allows you to collect all the dollars you otherwise may not have the time, resources, or proof to go after.

TRACE stands for TRacking All Communication Events.

Your marketing literature emphasizes the sophistication of your technology, yet you also stress outcomes and customer relationships. Is that a contradiction?

If you choose to be in the software business, especially application software, you’ve got to have both, living in harmony. An elegant solution is one that is technologically sophisticated behind the scenes, but to a customer, is very easy to use. A great example of this is Google Search.

Customer outcomes are the metrics that mean the most. We’ve had instances where we developed a solution and it’s not been palatable to our customers. We want to understand why. I would argue that the customer outcome is really the only metric that matters in the big scheme of things.

What do customers tell you about the ROI from reducing denials?

ROI is significant. I always tell CFOs and CEOs, “TRACE is a tool. The only thing I can guarantee is that if you don’t use it, you’ll get nothing out of it. If you’re not committed to its value propositions, then please don’t buy it. But if you stand behind it, then there can be great returns.”

Customers will find ROI in the dollars of denied claims recovery and the efficiencies in streamlining that process. Our customers also monitor staff and provide more thorough training with TRACE. When customers come back and say, “With TRACE, we claimed $2 million in revenue we would have otherwise lost,” that’s significant.

To sum it up, ROI can be as quick as six to 12 months. It can be as long as never if you don’t use the tool or use it incorrectly.

How do you think the ability to play back a telephone call has changed the behavior of both the payers and the employees?

What many of our customers have experienced is that once they share with the payers, “We have evidence of this communication event for this patient’s procedure on TRACE,” the payer’s behavior changes so as to positively adjudicate the claim.

It’s all about proof. If you can produce the evidence that justifies your position, insurance companies will pay. If you can’t, they will not pay. They’re going to hold the money until you can demonstrate to them that you performed in the way that was compliant to their contract.

Give me a couple of customer outcomes that you’ve seen that could be achievable in the average hospital.

A hospital in Atlanta overturned more than $2 million and prevented more than $4 million in denials by using TRACE to get reimbursed for services rendered. In New Orleans, a hospital used TRACE to fax notifications into Medicaid, reducing the time spent on the notification process by 93%. Additionally, their ALOS was reduced by 12% and they claim they get paid, on average, 30 days faster just because our solution brings clarity to the process.

Because of the efficiencies attained through capturing communication events, there are hospitals that have been able to restructure or reduce FTEs. I know there are other hospitals using TRACE and leveraging it into other areas, such as new employee training.

How do the products affect patient satisfaction?

With our OptiVox product, the goal is to keep the nurses more attentive to their patients rather than spending time at the nurse’s station. It is centered on communication hand-offs during shift changes. Typically during shift changes, everything gets hectic and your nurse may disappear for awhile. OptiVox is helping patients experience the same level of care during shift changes as they would in the middle of a shift.

The same thing is true about the TRACE product. Employees don’t get tangled up in as many payment and process issues if they use TRACE to bring clarity to what many times is vague at best.

Tell me more about OptiVox.

We have an outside advisory board formed from our customer base. We help them understand our business and we share with them our product road maps and where we’re going as a company. We get the heartbeat of what’s out there and what hospitals are experiencing.

One of the outcomes of our advisory board surrounded the Joint Commission initiative mandating structure and security regarding communication hand-offs, primarily when one nurse comes on shift and the other nurse is going off. It’s a communication event between these two nurses regarding information that, many times, never makes it to the chart.

JCAHO came in and said, “It’s too unruly the way that this information is being handled. You’re going to be held accountable to the structure and security of that information.”

We told JCAHO that we’d like to step in with OptiVox as a voice-based type technology that would facilitate this exchange. Because this information is captured, nurse management can hear and see the information being exchanged, enhancing patient safety and improving quality.

Has JCAHO reacted to any customers that are using the OptiVox product?

JCAHO was initially mandating some things that were a little stringent. We had a customer in the Chicago area go straight to JCAHO and say, “Listen, this is what the product does for us. These are the benefits that it has. Not only in quality and efficiency, but it’s also HIPAA-compliant and it helps us cut down some of our overtime.”

When JCAHO released their book, they couldn’t mention us by name, but they mentioned our method of doing it electronically through voice as an acceptable method. Without our customer giving their endorsement and confidence in OptiVox, I don’t think that we would have been included in their standards.

In the last couple of years, you’ve brought two major products to the market. What are your priorities going forward?

I’ve always said that if you want to get into the software business, then you need to know that applications have a shelf life of about four to seven years. After that, any solution will start getting stale. You must change as technology changes and provide solutions that are relevant to your customers. From 30,000 feet, that’s what we’ll continue to do.

That’s the strategic side. From the tactical side, we will continue to listen to our customers. The greatest adjective that you can get tagged with by one of your customers is “partner.” Once you both know that you’re a partner with them and they call you and say, “Guille. I’ve got this problem. Can you help me think through this?” then you know that you’ve built trust and earned their respect to come towards a solution.

Once we’ve listened to our customers, we’ll try to earn that status of being a partner with them so that they can include us in what they’re trying to solve instead of looking at us as just another vendor.

Here’s the important question. Are you going to have any really good giveaways at HIMSS?

Pictures of you and Mr. H, right? We have some great folks that come up with the most novel giveaways. We’ll have some good trinkets.

Anything else you want to add?

Our company’s values and our corporate purposes are probably a little different from what you typically see out there. Somebody shared with me that, while I’ll deal with a lot of things day to day like contracts, questions, and strategies, the only thing in my day that will last forever is people. Everything else will pass.

How we treat each other and our people … that’s where I get pretty steely-eyed and serious, because life’s too short. We spend most of our waking hours at work. I’m interested in creating an environment where we can treat each other with the respect that we each deserve and can be honest people of integrity. Not that we’re not going to make mistakes, but I’m going to own up to my mistakes and move on.

This seems pretty simple, but that’s where our core values reconcile back to our corporate purpose. And in so doing, it has created an environment that sets people free. They can work and use their God-given talents and skills in the way they were intended to use them. It makes it a fun place to work.

That doesn’t make us a bunch of sissies. I do not like to lose. I’m not a poor loser — I just don’t like to lose. That’s also the environment we’ve created. We want to compete and we want to win. We take winning seriously and we take losing seriously.

Fast Facts

Products
TRACE, OptiVox

Company
The White Stone Group, Inc.
2030 Falling Waters Road, Suite 250
Knoxville, TN 37922
800.864.2378
www.twsg.com

Notable Customers

Children’s Healthcare of Atlanta, Erlanger Health System, Mayo Clinic, MediSys Health Network, Provena Health, Tenet Healthcare, University of Arkansas for Medical Sciences

The Bottom Line

• TWSG’s products are running in nearly 400 hospitals to manage healthcare communication events through its digital communication record.
• Maintaining an easily retrievable digital multimedia archive to support existing information systems is technically elegant and highly functional.
• TWSG’s Web page includes a detailed Company Philosophy page, which is a must-read.

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