We partner with healthcare organizations across the country. Whether start-ups or Fortune 500 companies, we pride ourselves in producing results our clients demand.

Payer Case Studies

  • Telesales and Field Sales

    A predominant state health plan with almost 80% market share needed to prepare for a unique “private option” Medicaid expansion which would present as many as 250,000 new prospects. The federally-administered exchange was launching at the same time which presented both retention and new enrollment opportunities in the non-Medicaid individual market. The plan developed an acquisition and retention strategy which required a larger contact center operation and field sales presence statewide. The client engaged BroadPath to provide telesales, member retention, and field agent support with the understanding that a flexible partnership would be essential to succeed in a dynamic, rapidly evolving environment.

    • Challenge:
      Help our client capitalize on Medicaid expansion and the new exchange with highly flexible telesales and member retention solutions. Provide highly experienced licensed field agents to grow retail presence and enroll new members within the under and over-65 markets.
    • Solution:
      We deployed an end-to-end sales and member retention call center with 56 FFM-certified agents processing enrollments directly on the exchange. Our cloud-based ACD/IVR was used for telephony with the client providing a proprietary CRM and subsidy estimator tool. Our staff was trained by the client with BroadPath performing all management, QA, and scheduling. In the field, we deployed 42 licensed agents to staff 7 regional offices, 18 big-box locations, and 19 special event venues to sell Medicare, Medicaid, and individual plans. Our staff was co-managed by onsite client supervisors, BroadPath supervisors, and our regional Project Manager.
    • Results:
      The engagement was very successful for our client and allowed them to fully capitalize on the new opportunity while minimizing member churn. Overall our combined teams handled over 15,000 new enrollments and drove a member retention rate of over 85%.
  • Custom CRM Development

    A startup Medicare Advantage plan in eastern Tennessee hired BroadPath to provide a fully outsourced year-round telesales solution. At the time, executive leadership had not selected the core technology platforms to handle CRM and broker credentialing functions. BroadPath agreed to develop a customized CRM platform that would integrate with our telephony system, automate key field agent and telesales functions, handle the broker credentialing process, and facilitate CMS compliance and reporting.

    • Challenge:
      Develop an end-to-end solution, customized to the Medicare Advantage sales cycle, to manage the agent credentialing, field sales, telesales, and compliance functions.
    • Solution:
      Our team worked with the client to scope high-level functional requirements and began development.
      Highlights include:
      – New agent portal to automate credentialing, from application through writing number issuance.
      – Lead assignment rules to ensure high quality leads were assigned to most successful agents and were followed up on within 48 hours.
      – Sales event reservation system with Google maps integration.
      – OEV process automation and compliance reporting, including: call documentation and automatic letter triggers with mailroom integration.
      – Custom call scripting tool for streamlining call handling and enrollment processes.
    • Results:
      During the 2013 -2014 AEP, our Medicare CRM solution helped our client credential over 300 agents and automate the telesales and enrollment process for all new Medicare members. Our client continues to use our Medicare platform.
  • Field Sales Support

    A national Medicare Advantage plan needed additional agents to provide territory coverage during the Annual Election Period (AEP). They had previously worked through the broker agency channel (FMO, SGA, etc) with marginal results and had limited success hiring captive agents themselves. They hired BroadPath based on our national footprint and ability to deliver Medicare-experienced agents quickly.

    • Challenge:
      Quickly mobilize a team of Medicare-experienced licensed agents within to handle in-home appointments and facilitate sales seminars with a 12-state territory.
    • Solution:
      BroadPath assembled an experienced team of 12 licensed Medicare sales agents in less than 3 weeks. The agents were located around the country in 12 different states and focused on selling Medicare HMO and dual plans. Each agent worked 7-days each week to accommodate a range of meeting schedules. They used rented cars to cover each territory, following up on leads and facilitating sales seminars and community presentations.
    • Results:
      Our client was able to assign experienced BroadPath reps to uncovered and under-covered territories very quickly and with little preparation. Our agents delivered exceptional results with close ratios at or above their captive agent pool, and our solution was incorporated into the client’s AEP staffing model going forward.
  • Medicare Member Services

    A Medicare subsidiary of a top 5 health plan needed to increase the size of their member service headcount by 400% in a very short time period due to rapid business growth. In order to manage the larger headcount the client decided to implement IEX workforce management and also needed assistance with configuration and rollout of that system. The client turned to BroadPath to provide the more specialized management resources and consultants and to fill CSR headcount gaps if local temp agencies came up short.

    • Challenge:
      Minimize service impact to new members despite exponential growth by increasing member services headcount by 350 in less than six weeks. Onboard additional managers, supervisors, trainers, QA analysts, and WFM specialists. Configure and rollout IEX WFM tool to manage larger contact center.
    • Solution:
      We deployed 90 CSRs, 12 supervisors, 8 call auditors, 6 IEX specialists, and a site director over the course of four weeks. The BroadPath supervisory team managed all contract employees including local temps from other agencies. Our workforce management team implemented and configured the IEX WFM tool, scheduled the entire call center and executed real time adherence monitoring.
    • Results:
      The project spanned four locations in three states with the largest facility managed solely by BroadPath. The engagement was recognized as an unprecedented success and BroadPath received recognition from the company President.
  • Outbound Campaign

    One of the largest BCBS plans in the country decided to conduct a campaign to attempt collection of underpaid co-pays from approximately 22,000 Medicare members. The campaign needed to be conducted during AEP and there was no internal capacity available. However, management was hesitant to outsource given the sensitive nature of the calls. BroadPath was selected because of our ability to bring Medicare-experienced agents with the necessary soft skills to handle each call delicately with empathy and professionalism.

    • Challenge:
      Conduct an outbound campaign involving 22,000 Medicare beneficiaries, in a short period of time, and with the soft skills necessary to achieve collection goals while minimizing impact to member retention.
    • Solution:
      BroadPath worked with the client to develop a tactical plan that included a coordinated mail campaign, a blended inbound/outbound call center, customized call scripts, outbound auto-dialer, and a CRM call logging solution. We hired and trained 20 highly experienced Medicare Advantage agents to execute the campaign, and managed all aspects of the contact center including ACD/IVR telephony, training, supervision, coaching, QA, and reporting.
    • Results:
      We placed almost 60,000 calls within 2-weeks, attempting outreach to all 22,000 members several times. Our efforts were over 10x cash positive, resulting in significant new revenue while also reducing inbound call volume to the client’s existing call center.
  • Medicare Part B Appeals

    Our client was a Medicare Administrative Contractor (MAC) in two Medicare jurisdictions covering 11 states. They had recently taken over a new jurisdiction from a previous contractor and experienced a much higher Part B appeals workload than anticipated. The backlog had grown to over 120,000 cases with aging as high as 130 days. Due to the high volume, urgency, and significant complexity of Part B appeals workload, traditional solutions were not an option – they needed a partner who could ramp-up an independent operation very quickly. BroadPath’s proposal won CMS approval and we were awarded the contract.

    • Challenge:
      Quickly ramp-up a turnkey Part B Medicare appeals operation with enough capacity to process over 100,000 cases in less than 4-months with quality above 98%.
    • Solution:
      New hires were sourced nationally from 24 different states, all with extensive Medicare appeals experience. We hired 108 Appeals Analysts, 4 Supervisors, 2 QA Analysts, and a dedicated Project Manager with the first start group deployed 3-weeks after the initial client call. All staff flew into Tucson for the initial 3-week training which was conducted in a temporary leased facility. After training all resources were relocated to home-offices for the remainder of the engagement.The client provided access to CMS systems, train-the-trainer, and auditing support. BroadPath handled everything else including training, project management and supervision, QA, coaching, daily work assignments, production tracking and reporting, and provisioning of home office workstations.
    • Results:
      We quickly ramped up production over 6-weeks, completing over 8,000 cases per week at peak. For the entire project we maintained production and quality above client standards. Over the 4-month engagement we completed 94,988 appeals, after which inventory levels were down to normal and the project was concluded.

Payer Testimonials

  • “In addition to making our SLA’s we also achieved the highest member satisfaction in over four years during Q4 – a remarkable achievement given our high volume. Thanks to you and the entire BroadPath team for your critical support in achieving these goals. When we started talking early last year there were many unknowns… Happily it was a great plan and one that was proven to be very effective. Please share our thanks with your project management team and all the other key members of your team. My sincere thanks for your support and professionalism in working with us.”

    Director of Customer Service | Five-Star Rated Medicare Advantage Plan
  • “I cannot say enough about your team’s professionalism and excellent management skills. You made this engagement a piece of cake! Thank you for your responsiveness to any issue and your willingness to make this engagement “right”. Your phone number is on speed dial!!!!”

    Vice President-Operations | BCBS plan in Midwestern U.S.
  • “BroadPath staff was willing to do anything asked of them to take care of prospects and members. Attitudes were always positive and they were the ones willing to stay late. Their knowledge, personality and skills made this a smooth project.”

    Operations Manager | Blues Plan is Southeastern U.S.
  • “We are extremely happy with the BroadPath team.  They have really moved mountains here and everybody recognizes that.”

    Director Part B Claims | Top-rated CMS Administrative Contractor
  • “I want to personally thank each of you for a job well done. Because of your dedication and commitment to excellence, you not only reviewed over 6,000 records, but you completed the task on time. We are able to meet our deliverable because of you… You surpassed our expectations!”

    Department Supervisor | Top-rated CMS Administrative Contractor
  • “You and your team are doing a wonderful job managing through this very busy open enrollment. It’s challenging to balance staffing needs with high volume, nights, and weekends and continue to make outbound calls. The results show you are striking the appropriate balance. It’s great to hear the positive feedback from members… Your efforts are appreciated!!”

    Senior Vice President | One of the nation's highest rated regional plans

Provider Case Studies

  • PQRS Downward Modifier Appeal

    A Midwest critical access hospital that contracts with hospital owned physician practices and independent physicians, sought compliance with federal regulations after not submitting data to the Physician Quality Reporting System (PQRS).  The hospital was notified by the CMS of downward modifiers that cost them 1.5 percent of their part B revenue in 2015.

    • Challenge:
      The company sought to identify and address the reasons for their assignment of the downward modifier in order to realize greater profit in the upcoming years.
    • Solution:
      Broadpath began by identifying and clarifying the hospital’s designation under CMS, then developed a plan for implementing the PQRS filing system for 2015, and appealed the 2013 downward modifier.
    • Results:
      The hospital greatly increased their revenue, developed a plan for future filing, and adjusted their modifier.
  • GPRO Deadline

    A 1,500 employee anesthesiologist management organization, on the East Coast, struggled to find the specialized resources and expertise necessary to meet the PQRS deadline. They requested help reporting their data after learning that their QCDR (Qualified Data Registry Reporting) did not support the GPRO (Group Practice Reporting Option).

    • Challenge:
      Determine and understand what patient data to report to the CMS in less than a month.
    • Solution:
      Locate reserves of qualified help to identify, organize and file relevant patient records.
    • Results:
      BroadPath compiled, organized, and reported on over 220,000 applicable patient records to the CMS from across multiple data sources in under a month. Thus, ensuring successful submission to PQRS  by the deadline. This organization is now the leading specialty anesthesia management company in the United States.
  • Workflows & ICD-10 Readiness

    A group practice in the Southwest needed to implement a new EHR system to reduce excessive patient paperwork that was contributing to patient no-shows. They also needed to improve their interoffice communication with other providers and ancillary services. Then prepare for the financial and medical impact of the transition to ICD-10.

    • Challenge:
      Prepare for ICD-10, improve communication between provider and ancillary offices, and reduce patient paperwork.
    • Solution:
      BroadPath implemented a new EHR system that included a patient portal with pre-appointment check-in functionality to reduce check-in time and no shows.  We then prepared an ICD-10 transition plan.
    • Results:
      Implementation of the EHR system resulted in a significant decrease in patient check-in time and associated paperwork. The EHR increased the efficiency of communication and information exchange between other providers and ancillary services. Broadpath also collaborated with the EHR vendor to upgrade the ICD dictionary to contain ICD-10 codes.

Provider Testimonials

  • “BroadPath helped us strategize our approach to improving our success towards the goal of achieving the “high quality – low cost” designation on CMS’ Physician’s Compare website.  With the move from volume to value, we want to be in a position of maximum flexibility in our ability to choose the best partners, and to negotiate from strength with our payers.  BroadPath’s physician and regulatory compliance experts gave us the business perspective we needed to report effectively to PQRS, by picking clinically relevant measures and streamlining the data collection and reporting process.”

    Chief Clinical Operating Officer | Large provider network in Southwestern U.S.
  • “BroadPath offered us an economical and efficient method to meet the 2014 PQRS requirements, and avoid reimbursement penalties from making the wrong choices for our 30 eligible providers. Their response to our needs throughout was quick and helpful.  Their demeanor was always friendly and caring.  Their ultimate goal was to help us improve quality care for our patients, as well as meet the PQRS requirements. We are using their assistance again with 2015 PQRS measure selections, counseling of the requirements, and data scrubbing and submission”

    Director of Quality Services | Critical Access Hospital in Western U.S,
  • “BroadPath cost-effectively complemented our existing staff with the dedicated focus and regulatory compliance experience we needed. We have a small and busy staff, and BroadPath was reliable and accurate in helping us submit to PQRS last year. We also are using them to help us find ways to overcome barriers to successful MU attestation this year.”

    Physician Practice Director | Group practice in Northeastern U.S.
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