When Greg Flanagan joined AP Health as an equity partner and COO, the business was operating as many small and midsized organizations do. Manual, paper-based and spreadsheet-based workflows were stifling the healthcare services company. Inefficient processes, susceptible to human error, were adding costs, exposing the business to risk and constraining growth.
AP Health provides credentialed Advanced Practice Providers (APPs) staff to hospitals and surgery centers. Its Practitioners work an average of 3 surgical cases per day, and the company uses what it calls a ‘Facesheet’ – a one-page case summary completed by each Practitioner – as a document-of-record for each case. Facesheets include all pertinent case information – the names of the hospital and surgeon, time-in and time-out, patient information, insurance information, notes about the surgery, and more –, and they drive the company’s back-office workflow, from scheduling to billing.
“Our practitioners were faxing Facesheets to the office, or they were dropping the paper sheets in our coordinators’ mailboxes at the end of the day. Collecting, assimilating and passing along all that information among departments efficiently was a huge challenge. Our coordinators were typing information into spreadsheets. Errors were common, and we had stacks of unbilled cases,” Flanagan recalls.
Often, staff would work into the evening to schedule providers for the next day’s cases, manually entering schedules into an Excel spreadsheet and emailing each provider. “Everybody was waiting for the schedule email to come out, and inevitably there were changes. We needed a way for the provider to see their schedule in real-time,” Flanagan says.
At the time, AP Health had only 12 employees and two client contracts. Scaling the business was Flanagan’s primary objective. “That first day I walked out and went, oh, my God, this isn’t going to scale.”
Partnering with FortyAU – a ‘casual agile’ development methodology
“Every small business gets to a point where they ask, can I get by with nothing, or do I make an investment in software and let my business grow? And if they make that investment, as Advancing Practitioners has, it has to pay off,” says Andrew Kerr, Managing Partner of FortyAU. “But they didn’t try to eat the whole elephant at once. That’s important. It’s been an incremental process, an ongoing collaborative partnership.”
That collaboration began with a process review, with Flanagan outlining AP Health’s requirements and explaining its business workflow to a small team from FortyAU. “They’d listen and ask questions,” Flanagan says. “Andrew, who has a deep healthcare background, understood most of what I was saying immediately, so he translated our requirements into system design. From there, FortyAU took over architecture, design, programming and project management, coming up with designs and estimates. We’d iterate on that and then lock it in.”
From the start, AP Health has prioritized feature development to satisfy a current need rather than what might be nice to have, a wise approach for a small business, in Kerr’s judgment. “We’ll work on features important to their business now, knowing we can table other development for later,” he says. “That fits perfectly with FortyAU’s ability to scale our development resources to match their requirements at any given time. They’re not paying for a developer when they’re not using one.”
FortyAU works in two-week sprints, what Flanagan calls a ‘casual agile’ approach to developing custom solutions. “They employ an agile development methodology, but there’s no scrum master or project management line item. It’s just weaved into their development process, and Andrew invests a lot of time personally in the project.” FortyAU also provides an online portal to facilitate collaboration as Advancing Practitioners’ requirements moved from development to testing, QA and production.
Building a mobile app and a back-office portal
Flanagan’s initial priorities were to build a web portal replacing the spreadsheets used in the back-office and to deploy a mobile app for the company’s practitioners use to securely capture and submit their surgical case information from the hospital.
With the administrative portal, FortyAU built what is essentially an internal workflow engine, a centralized, single source of real-time truth on each case. AP Health’s back-office team manages the scheduling of cases, reconciling data, coding cases for billing and sending that data to a billing module, ensuring data integrity throughout the process. An SQL database enables Advancing Practitioners to enforce master data management methods and other practices not feasible using Excel spreadsheets.
Through the mobile app, practitioners in the field capture case details and feed information into the case pipeline. FortyAU built an integration with Azure Directory to manage employee sign-ins and with One Drive to store the Face Sheet images uploaded by the practitioners, while ensuring security. Next-day case schedules for each practitioner are published to the mobile app at 5:00 each day, with text alerts to any changes in that schedule. FortyAU later built an integration with hospital scheduling systems, automatically uploading their surgical case schedules at each afternoon, looking forward five days. “Data integration is the key to administrative simplification and improved productivity,” says Flanagan. “We need to be as efficient as we can to be successful with delivering high quality service to our hospital clients”
Over two years into his partnership with FortyAU, Flanagan says, “My vision was and remains, anything we can automate at a reasonable expense, let’s do it. Let’s take manual data entry and cumbersome processes off the plates of our clinicians” In his own case, Flanagan estimates he used to spend 80%-90% of his time managing back-office administration. He now dedicates about a quarter of his time. “My life has completely changed. I’ve reclaimed that time to focus on improving revenue cycles and business development,” he says. “And our accounting team has gotten three days back every month because our invoicing process is now a push of a button.”
“I’ve always dreamed about running a company that has no full-time IT employees, and with my infrastructure housed with Microsoft and my apps developed by FortyAU, I’m able to achieve that,” Flanagan says. “We are an internet native company and we’ve grown into a company with close to 100 employees, and none of them are in IT. I think that’s the value of the partnership with FortyAU. Their price-to-service value is great. It makes it easy to say I’d rather partner than try to build it myself.”