Empowering Comanche County Medical Center’s Growth and Efficiency

Executive Summary

For years, Tribunus Health has partnered with Comanche County Medical Center Health System (CCMC), a rural healthcare provider in Texas, to optimize their contract management and credentialing processes. This case study explores how Tribunus Health’s expertise has helped CCMC expand its services, streamline operations, and position itself for future growth.

Background

Comanche County Medical Center Health System (CCMC), is a 25-bed non-profit organization serving Comanche, Erath and the surrounding counties. With a network of thirteen clinics and specialized services, CCMC plays a vital role in delivering healthcare to its community. Initially focused on basic medical services, the hospital has expanded its offerings to include rural health clinics, specialized clinics, such as diabetic infusion centers and an occupational health clinic, along with featured services such as surgery and cardiac rehabilitation.

Challenges

As Comanche County Medical Center Health System aspired to expand its services and footprints, it faced several challenges: 

1. Contract Management: The variation of service offerings and providers across locations, hindering their ability to manage payer contracts and operationalize them successfully.
2. Credentialing Complexities: The process of credentialing providers across multiple locations and payers with multiple products, was overwhelming. Payers’ complex and unclear credentialing programs exacerbated the difficulty of managing this work.
3. Limited Resources: As a rural hospital system, CCMC struggled with limited staff to effectively manage payor contracts and credentialing.

The Tribunus Health Solution

Tribunus Health partnered with CCMC to address these challenges and support their growth. Our approach included:

Comprehensive Contract Review: We conducted a thorough review of existing contracts, prioritizing alignment between hospital and clinic agreements to ensure that all entities operated under the same terms.

Streamlined Credentialing: Our team took over the credentialing process, managing approximately 400 health plan enrollments. We initiated a comprehensive audit of all provider CAQH records to identify outdated documents as well as missing and incorrect data so that initial applications and recredentialing were not delayed with the plans. We then processed 250 credentialing applications in just four months.


Strategic Expansion Support: We contracted at competitive rates for new clinics and services, including diabetic infusion centers and an occupational health clinic, enabling CCMC to broaden its service offerings significantly.

Regular Communication: We established bi-weekly meetings to discuss the status of credentialing and contracting, providing a clear outline of all providers, health plans, and their respective statuses. This transparency allowed CCMC to track progress efficiently.

Results and Impact

Our partnership with Comanche County Medical Center Health System yielded significant results:

Improved Organization: We provided support in organizing their contracts and respective terms better, providing enhanced clarity for CCMC’s leadership.

Increased Visibility: Our credentialing team provides ongoing clear status updates on all providers and health plans, facilitating improved billing and receivables management.

Expanded Service Offerings: We negotiated new contracts for the hospital, new rural health clinics, four diabetic infusion clinics and an occupational health clinic, which directly contributed to increased patient visits and associated revenue.

Enhanced Business Opportunities: By completing contracts for all entities, we opened doors for new business opportunities. We developed productive relationships with multiple payers on CCMC’s behalf which allows them to more easily and expeditiously continue to add any new services and locations to payer networks.

Negotiation for Higher Rates: With most initial contracts completed, we are now evaluating opportunities to negotiate higher rates for Comanche County Medical Center Health System, further enhancing their revenue potential.

Ongoing Collaboration

As our partnership continues to evolve, we are focusing on:

Rate Negotiations: Evaluating opportunities to negotiate higher rates for Comanche County Medical Center Health System based on their expanded service offerings.

Continuous Improvement: Regularly reassessing contracts and identifying new opportunities for the client while maintaining open lines of communication regarding any ongoing issues or needs.

Resource Refinement: Continuously collaborating with Comanche County Medical Center Health System to ensure we are providing the most useful reference tools for them to understand their contracting and credentialing status.

Client Satisfaction

Comanche County Medical Center Health System has expressed high satisfaction with our partnership, particularly appreciating our successful integration to essentially become an extension of their team in managing contracts and credentialing processes. Despite not unexpected challenges along the way, overall feedback has been overwhelmingly positive.

Tribunus Health has become an invaluable partner in our growth and operational efficiency. Their expertise in contract management and credentialing has allowed us to focus on what we do best – providing quality healthcare to our community.”

– Tamra Wells, Director of Business Office & Revenue Cycle Management

Conclusion

The partnership between Tribunus Health and Comanche County Medical Center Health System demonstrates the power of strategic collaboration in healthcare administration. By leveraging our expertise, Comanche County Medical Center Health System has been able to expand its services, streamline operations, and position itself for continued growth and success in serving its rural community.

Lessons Learned

Critical Access Hospitals and Rural Health Clinics are contracted and credentialed by most payers according to different requirements than other provider types. Given Comanche County Medical Center Health System has both these and other general types of providers, just understanding the processes is a challenge. It was important for Tribunus Health to not only carry out the work of contracting and credentialing, but also to educate the Comanche County Medical Center Health System team along the way. Additionally, payers often provide conflicting information to both CCMC and Tribunus. Together, we have worked to ensure we are constantly communicating with one another and documenting along the way to ensure no payer miscommunication adversely affects our Client.


By continuing this collaborative journey, Tribunus Health aims not only to meet the current needs of Comanche County Medical Center Health System but also to anticipate future challenges and opportunities within the evolving landscape of rural healthcare.