ACL Success Story – Healthcare – Palomar Pomerado Health

2011-06-01

Palomar Pomerado Health

“Analytics Exchange 2.0 enables real-time communication between auditors, stakeholders and management. It’s a huge advantage for our continuous monitoring plan and the improved security strengthens our ongoing compliance efforts.”

Tom Boyle, District Audit Officer, Palomar Pomerado Health

Company Overview

Palomar Pomerado Health is the largest U.S. health care district, serving communities in an 800 square mile area and a trauma center that covers 1,440 square miles of South Riverside and North San Diego counties. In addition to two hospitals, Palomar Pomerado Health offers home health care, surgery, skilled nursing, ambulatory care, behavioral health services, wound care, and community health education programs.

Beta Objectives

Communicating critical data and transactional anomalies to business stakeholders can be a complicated process. For the Palomar Pomerado Health (PPH) audit team, the time required to send reports, cut and paste results, and incorporate exception details into working papers takes away from investigative audit work that could provide more targeted control assurance.

PPH was already using ACL Analytics Exchange 1.0 and was eager for an extended solution that would support seamless, standardised communication between managers, stakeholders and the audit team. In addition, the department has a continuous monitoring plan that aims to transfer the responsibility for pulling data, testing its integrity, and running automated analytics from technical audit staff to end users and business department owners.

Implementation, Planning and Experience

PPH successfully completed a full installation and test of the beta ACL Analytics Exchange (AX) 2.0 solution. The team began by implementing ACL’s new AX Accelerators, which are packaged analytics designed to automate key audit objectives. ACL consultants worked on-site, side-by-side with the PPH audit team to streamline the installation process and ensure staff fully understood the Analytics Exchange 2.0 applications and capabilities. “That was a real time saver,” said Tom Boyle, District Audit Officer for PPH. “We were very pleased to have skilled guides throughout the migration process and the consultants onsite proved to be invaluable. We are light years ahead of where we’d be if we had tried to do it all ourselves.”

As part of the PPH continuous monitoring plan, data specialist Steve Barrett is using Analytics Exchange 2.0 to develop a billing validation solution that monitors medical cases and procedures to find missing charges – before patients are discharged from PPH facilities or bills are closed. The custom solution uses 12-month historical data to match daily surgical procedures with pharmaceuticals, therapeutic interventions, devices and medical services that commonly accompany these procedures. The new AXException component then sends a report that pinpoints potential missed charges to the ancillary area. With Analytics Exchange 2.0, PPH will have continuous monitoring and efficient follow-up with stakeholders who can make timely billing corrections.

Next Steps

The PPH audit team is committed to implementing audit best practices that address potential revenue leakages, make efficient use of resources, and utilise automated data analytics to strengthen the control environment. With the enhanced AX Core data repository, auditors can quickly pull secure data files from the main server without using valuable bandwidth. Data access tasks that used to take 10 hours, for example, can now be completed in an hour or less.

The audit team expects to see significant cost recoveries, both by identifying real-time billing errors and by increasing the efficiency, consistency and reliability of audit work and communication with business owners. The AX Exception component will help auditors save time and standardise reporting protocols, while shortening the lifecycle of individual audits and strengthening internal processes.

Data security and patient privacy is another critical concern for a health care organisation such as PPH. The team expects Analytics Exchange 2.0 to greatly improve data security by ensuring airtight data access rights and viewing privileges. AX Exception eliminates the need to e-mail private files and the new AX Gateway interface can prevent inappropriate data exposure by allowing viewing of information within AX Core without moving data out of the repository. This also supports compliance with robust state, HIPAA and other IT or regulatory requirements.

PPH has closely aligned its audit and control objectives with Analytics Exchange 2.0 and will be incorporating accountability measures to ensure automated analytics are used to the fullest extent possible. The platform provides them with efficient stakeholder communication, improved data analysis and better security access for the entire department.