Episode 43: How to Prepare for Year End

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Transcript: How to Prepare for Year End

Dylan McCabe: We Infuse podcast, episode number 43. Welcome to the We Infuse podcast. My name is Dylan McCabe. And in every episode, we give you a seat at the table as we talk with infusion center owners and operators and industry experts so that you can get the wisdom you need to run a successful infusion practice. Now, in this episode, I have Elizabeth Johnson on the show. She’s the president and co founder. founder of nonprofit NAMAPA. She’s also the CEO of Medeco CX, a physician buying group. And she really brings a lot to the table when it comes to best practices, education, equipping, and how to, we’re going to get into how to prepare for the end of the year and start the first quarter strong in your infusion practice. They even have a guide that they offer. To, people who join their group. So there’s a lot to learn from this episode. I think you’re going to get a lot out of it. And if you have not done so already, you owe it to yourself to get a demo of the WeInfuse software. You will be absolutely blown away at how it simplifies and streamlines the Infusion Center workflow. It’s truly a remarkable platform and, makes, as we say, it takes the confusion out of everything. infusion. All right, guys, let’s jump into this episode with Elizabeth Johnson. As I mentioned, we have special guests on the show today, Elizabeth Johnson. So Elizabeth, thank you for joining the show.

Elizabeth Johnson: Absolutely. Thanks for having me.

Dylan McCabe: We’re glad to have you on. And I always like to give our guests just a few minutes to talk about their background and how they got into the world of healthcare up to the point. So Just give our guests a little bit of background info on your, journey in healthcare.

Elizabeth Johnson: Sure. Absolutely. so I’m a nurse by trade. I’ve been in healthcare a little over 10 years now. I started out in an allergy practice that I actually found the job posting on Craigslist. I graduated nursing school and worked in the hospital for a little bit and needed some different hours. So I worked private practice and I thought food allergy, runny nose. it’s going to be no problem. shortly after a nurse that was there retired and handed me this big box for a biologic we had out at the time, Zolaire, and goes, here, it’s yours, figure it out. And so I very quickly had to learn the world of specialty medications, prior authorization, insurance, and all that. And so worked my way up from working in a provider’s office, running as a clinical coordinator, Up to a corporate level. I happen to work for a large group and built a centralized buy and bill process for them. So learned a lot about insurance and access and pharmacy versus medical benefit. So spent the last six years doing that. did a lot of great things. I’ve partnered with a lot of manufacturers. and other organizations, which, we’ll talk about today about the nonprofit that we’ve started and really stuck my hands anywhere I could to learn, what’s best for our patients and what’s best for providers.

Dylan McCabe: That’s great. So you’ve become deeply immersed in infusion and you’ve made some really good connections in the industry. And like you mentioned, now you are, you’re involved in two things. You’re the president and co founder of a nonprofit called NAMAPA and you’re also the ceo of Medeco CX. So Let’s talk about those. what, are you doing?

Elizabeth Johnson: Yeah, that’s, it’s a lot to unpack. they overlap and, I get to, hang out with a lot of great people because of that. So, a little, almost two years ago now, I was coming back with a friend of mine from a speaking engagement and we started talking about what’s your five year plan. What do you want to do? What do you want to accomplish? And, Why we talk about that on an airplane? That’s just our lives. but we both had mentioned that we wanted to give back and a non profit would be the way to go. So NMAPA stands for the National Association of Medication Access and Patient Advocacy. we’ve tried to shorten it. We tried to explain what we do in, less words, and for a better acronym, but that’s what we landed on. And. The main focus is education and providers, there’s a lot geared towards them and there’s a lot geared towards patient advocacy and I’m a full supporter of both of those, but as a previous biologics coordinator myself, I couldn’t find anyone in allergy. It took a lot to finally make connections. And to find resources that would help me out. So NMAPA’s goal is to provide education to those in between provider and patient. And we tried to do therapeutic specific area, but access is access. And we wanted to really blanket that and reach out to those, that may have questions. And if for those that are looking for a career change or career growth, we don’t want to limit them to just one area. So we’ll teach about everything and make our advocates stronger. I think that’s made me, I’m in the allergy space historically, that made me better in my space to learn about oncology, learn about rheumatology. So we work with everyone from coordinators to pharmacy techs to financial counselors to pharmacists, nurses, they’re all crammed in there. but that also led me to my day job where I was able to connect with providers who wanted to provide education, but also provide resources, and aggregated, purchasing to physicians. And so my job at Medeco CX is, I’m a CEO, I have a team of five, and we help physician practices, solo physicians, Purchase and source biologics, both injectable and infusible, at better rates. but we also really work on their staff, right? Doctors can write scripts, but if they don’t have the staff to navigate the access process, the patient doesn’t end up on drug, or if they don’t end up with copay assistance and some of these other really necessary things. So I get to sit in a really cool spot with a really great title, and help patients. members and I love it.

Dylan McCabe: That’s great. Well, that’s why we were excited to have you on the show because we want to have people on like you who have leadership roles, who are, you are accountable for some really neat stuff like education, equipping, bringing people together. That’s, what you do every single day. So I know for this show, we’re going to really focus on the Mappa. So you mentioned, the map of focus is on education and there’s a lot of education and equipping and resources out there. So what’s the problem that you guys saw? What was the opportunity that you saw where there was. a need there that you guys can meet with NMAPA?

Elizabeth Johnson: Sure. So I see a lot of therapeutic specific organizations and I love each and every one of them. I think they do a great job advocating for their disease states. but what I felt was missing and what my team felt was missing was the basics, right? Right now in healthcare, how many times have you heard we’re short staffed, we’re overworked, people are burning out. So what could we bring to the table to help that and give people. That foundation in that, fallback of like, okay, I can learn this. So we really stuck with the one on one, right? What is pharmacy benefit versus medical benefit? What is a prior authorization versus a predetermination? these simple things that those of us that are in this role, we speak the lingo, but what if you don’t, what if you’re We see it all the time. It gets passed to someone in the office, or it gets passed over to someone, and they’re playing catch up. Maybe they’ve been a biller, so they know the medical terminology, but not the rest. So it’s all inclusive. It is meant for any skill level, from beginner to advanced. And I’m really, I love when the most advanced individuals come to us, Read through material and say, that refreshed me or that re energized me because I haven’t been over the basics in a while.

Dylan McCabe: So let’s say we’ve got an infusion center and infusion practice and they hire a new M. A. and they want to get them caught up to speed on the different facets of the practice. How do you guys, I know you’re You’re trying to reach those people like that, that are not necessarily hearing this stuff all the time. How do you guys help them?

Elizabeth Johnson: Sure. So I’ll talk about the here and now. So we’re in November, going into December and into the end of the year. So what can you do for your infusion center right now? What’s going to set you up for the best January one. So that, part of the year is called the blizzard. And it comes from all the papers that fly through fax machines for that time of year. or in this case electronic fax. and so what can you do to set that up? What does balancing your inventory look like for the end of the year? what does, getting your patients scheduled appropriately? So we’ve created a guide. We’ve got one for both the blizzard and what you should start doing in January. It’s available on our website for download. so we just try to push material. We push it through social media. and then all with the common goal of, Hey, there’s patient letters in their examples, signs you can hang in your infusion center. So download it, take a look, see if it applies to your practice.

Dylan McCabe: That is so good. So for this, gap that you saw where there was a need for people who need to be equipped and educated, what has been your biggest, takeaway or maybe light bulb moment that you had when you guys started reaching out to your, target audience?

Elizabeth Johnson: Sure. I think it varies in, in that skill level, right? We’ve, I’ve spoken with practices who I’ve worked with for a long time and just the simple organization of it, right? They get overwhelmed. open enrollment starts patients are calling asking what insurance should I get and, being able to say, Hey, listen, here’s resources to give your patients, especially your Medicare demographic so that burden is lifted off the practice. We know our patients, so we tend to get involved and want to answer and help them with all their stuff. But we need to handle it the right way. We need to make sure we utilize what’s out there. So that’s been great down to someone who’s brand new and they don’t know the difference between specialty pharmacy and buying bill. So what does that look like first of the year? What does that look like in general? Where do I go? And I think through all of it, it’s really pushed us to leverage our manufacturer resources. I will personally say, I get so caught up, especially in the prior authorization space of I’m going to get this approved. I forget what’s out there from our manufacturer partners. And so reminding, these infusion centers and these practices that you do have a friend and a colleague to walk you through this stuff. And, don’t be afraid to pick up the phone and call. I always highlight the field reimbursement or FRM role. Those are HIPAA compliant roles, so they can talk to you about your patients, they’re there for you. And a lot of times, Reps get shut out of locations and they’re not allowed back in and I understand with COVID we’ve had different precautions in place, but that person, if you don’t know who your FRM is, contact NMAPA, contact someone else for that pharmaceutical company, but find your person. they’re such a valuable resource and if they don’t know, they’re great at escalating, they’re great at connecting. but that they are there for you. that is your person. Please lean on them. I know I speak with my frms for my different medications at least once a week, if not more. it’s just such a great role to have. And for those that are looking to get into a field reimbursement role, I think these coordinators that do this process, they are great setups for field reimbursement. So, having those discussions, what that would look like, it’s also incredible to have.

Dylan McCabe: So for practices that are dealing with this and they are dealing with the blizzard, like you call it, or just the difficulty of, running a practice day to day, and you’re just talking about field reimbursement reps and stuff like that. What’s one big piece of advice that you could give just to impart some, wisdom off of what you’ve learned and working with the different practices you’ve learned? if an infusion press, somebody owning an infusion practice or running an infusion practice, listening to this, what’s one key piece of advice you’d want to give them on how to make this easier?

Elizabeth Johnson: Sure. I can tell you the minute I walk in. So in my life, I’ve done some consulting, in various practices and centers. And the one thing that I can always tell when I walk in the door is if they don’t have a list of their patients, right. And you can go as simple as Excel, but have a list of the patients, what medication they’re on, what their prior off dates may be, their payer. That they can quickly reference at any point that is transparent, right? Anyone in that center or that office could look at and see if you don’t know who your patients are on buy and bill on specialty pharmacy and on free drug, right? Have those separated out. That’s my first indicator that they may not have a good grasp on what’s going on in that, center. So my most basic, simple piece of advice is have a list of patients that are actively receiving treatment, as well as, okay. make a tab on that spreadsheet of who’s discontinued. And so in an infusion center, a little bit different as scripts are being sent to them to, service those patients. still have that, have the reason they stopped. if they, if it’s been three attempts and they haven’t come back, make sure all that’s included and in your EHR, of course, that kind of information just, it goes leaps and bounds. If you’re trying to look at, further process improvement from there, identifying payer issues or trends, it, it seems like it’s the most common and basic thing that everyone would already have, but That is, usually the number one thing I find that’s not done.

Dylan McCabe: Interesting. All right. So that’s a challenge to those of you listening. Do you have that list? Is it easily accessible by all? Is it, followed by all? Is it, is it reviewed often enough? So that’s a good challenge. It’s a good reminder.

Elizabeth Johnson: Yeah. It leads to inventory management and, depending on how you stock drug and all that. It really, it is the core of what you should build off of. I was just in some practices these last two days. And the first question I ask in prep for these meetings is, do your patient list? And one didn’t have one. And it was a great way to segue into, how do you track authorizations? How do you track inventory? what do you do this time of year? So it’s a good conversation starter if you don’t have it. it’s not a bad thing. We can get on the other side of it. But yeah, I, that’s a great challenge to pose. Do you have that list?

Dylan McCabe: Okay, so I know one of the other things that you’re particularly passionate about is really preparing for the end of the year. So what do you mean by that? What does that look like?

Elizabeth Johnson: Yeah, absolutely. I, the end of the year is tough because we’re rolling into the January one policy changes. fee schedules can change. There’s a lot that happens and we don’t want a patient to fall through the cracks, right? We can get so caught up in the process of it, what’s going on and what we have to do that a patient could really get left behind. So I say take full advantage of manufacturer resources. there are recertification or re verification lists. a lot of these portals from our manufacturers have, the ability for us to get a list of all the patients we’ve sent through. It’s a great time to check their appointment history, check if they have inventory on hand, any of those pieces and parts. But also, what are you going to do as a staff come January 1, when a patient walks in with a new insurance card? Who’s going to take benefits? Who’s going to take authorization? And so instead of panicking the moment they walk in with a change, you have a plan in place. This, reserve this person’s resources for, checking that benefit, this person’s going to immediately pick up the phone for the authorization, or do you have voicemail messages, text servicing, what everybody has now to communicate with patients, your portal, who’s changing that and who’s monitoring it. And then also to the staffing point, when a patient comes in. You really have to ask like five different ways. Do you have new insurance? if we ask that, we get it. Oh, no, I’m fine. But did you get a new card? Do you have an app now, asking all those different ways and having multiple staff members ask again, we don’t want to like berate our patients with questions, but we want to make sure for their protection and for our practices protection. We’ve asked that question and been as thorough as we can with it. if you don’t have a policy in place now to check eligibility two days prior to an appointment, please start doing that. Protect your infusion center. make sure you’re looking at that kind of stuff, especially if you take Medicaid or some of these other plans. You want to check eligibility so that you can help the patient. Maybe they need to re enroll. Maybe they need to, call some, a counselor, something like that. So, with that patient centric mind focus, we can really protect our infusion centers that way. Also, end of the year, beginning of the year, people take off. We got the holidays. We’re closed. Just making sure that continuity of care rolls all the way through.

Dylan McCabe: So good. So one of the first things you mentioned there was leveraging your manufacturer relationships. So for some people do that really well. Some people don’t. So what’s something simple you could say that somebody should to do to start that process and get what they need.

Elizabeth Johnson: I like to go through, so I’m sure everyone has like a stack of business cards or somebody’s contact info somewhere. Go through and make sure you have the right business card for the person taking care of your area. They can change, there’s been some territory remapping, I know with the medications I cover. So make sure you have the right point of contact in case you need them. I’m pro manufacturer resources, so I’m always talking, to them, but if you’re not, you Check your contacts so they’re there if you need them. And then, yeah, go from there.

Dylan McCabe: That’s good. it’s all about leveraging. We all stand on the shoulders of others. The more you work with other people as a team, the easier it’s going to be. I think, and the next thing you mentioned was making sure people have predefined roles to accommodate this blizzard that comes at the end of the year. And so that really speaks to your organizational accountability chart. making sure you have the right people in the right seats, making sure each one of those people in those seats have three to five things that they are really responsible for. So what’s a good way that you guys keep a handle on that? Or how do you coach people that are part of the map to keep a handle on that? Cause for, I think for people that are, for some physicians or some people who run infusion practices, that’s not their, first line of sight is I’m going to revamp my org chart before the end of the year.

Elizabeth Johnson: Yeah. So I think an allergy, we may be a little spoiled with this because we have practices that if you have an anaphylaxis or allergic reaction, we tend to assign a staff member a role. So we have this pre assigned mentality already. So if somebody goes into anaphylaxis, one person’s charting, one person’s IV, one person’s epi, so we’re used to that. But, I passed that information along. So what we do is we look at who’s quick at certain things. We kind of leverage people’s skill sets, right? If someone is, knows those payers really well, knows a back line or knows how to get through, they’re our benefits person. biologics coordinator, someone really good with prior authorizations, maybe knows the portals, knows which way to acquire those quicker. That’s their kind of role. And we just sit around and talk about it. Staff meetings are so important, especially at the end of the year. I know we tend to let those slip because again, we’re all busy. We’re all short staffed, but those are really important. So discussing that through, as well as leveraging practice managers. they know the ins and outs of what’s going on or infusion center managers, who’s doing what staffing ratios, making sure we have coverage that way.

Dylan McCabe: That’s good. I think it’s, it’s, great when you’ve already made a decision ahead of time and you’ve got those processes in place. So when we talk about that, especially preparing for the end of the year, do you guys have like an end of the year process or an end of the year checklist, or is it just stuff that, tell me about that.

Elizabeth Johnson: So I have, in our end of year guide and our blizzard guide, we have checklists actually starting in October of things we recommend doing every single month. and it goes through March, what to be doing, because again, some policies change whenever some change first of the year, first, the second quarter. So how to look ahead to those kinds of things. The checklist or tried and true, I put them in practice at all the locations I’ve been with before, but I’m always open for feedback, right? I’m not perfect. I’m not the end. I’ll be all, I know what’s worked for me, but there could be other tips or tricks suggestions out there. I default to this blue cross of Texas. They have this really great manual. Of an examples of insurance cards, what is the little suitcase in the corner mean? I love all that info, but I’m sure there’s more out there that I haven’t come across. And I always, open for suggestions or if you know of something so that we can one update these guides, but two, there could be an inefficiency that I can correct by, being aware of this. So yeah, there’s, a lot of, stuff out there, but there’s great room for communication and open dialogue around these.

Dylan McCabe: That’s so good. I love that you guys have a checklist that makes it really simple and simple is always better. So, that’s the tagline and we infuse we take the confusion out of infusion. And so when you talk about that checklist and those guides that you guys offer, you mentioned that it goes through the end of the first quarter of the following year. So what does that look like? What is it? What if you could have whatever you wanted for an infusion practice, what would they be doing January, February, March?

Elizabeth Johnson: So they’re going to be faced with the natural, cycle of what healthcare is the first of the year, right? Whole times are going to be awful. And pardon my language, they’re going to suck. Someone in your staff is going to be sitting there for unnecessary time. and there’s just nothing we can do about that. Prior auths are going to take longer. the determination, they may say 10, 15 days, some may say two days, but we all know it’s going to be pushed out. So it’s patience, right? have some patience, have some, understanding that you could be multitasking. The average coordinator may be on the phone and then typing one in at the same time. So just know that your, workflow may be a little different, but we put it through that first quarter. Really to, say, to start, especially an allergy, right? We’re very seasonal, but to always be looking ahead to the next trend and how can you set yourself up for that next part, that next trend that’s coming. in February, especially things should be getting better, but they may not be, we may be behind. If we think back to 2021, going into this year, we were already behind because of COVID. So there was already that catch up. Then the first of the year, I would, love to say that I think 2022 might be a little bit better, but as soon as I say that, it’s going to absolutely backfire on me. So I’m hoping that this new year, We’re less of a lag and less, less struggle than we were before. But I know that for my coordinators, what I am recommending to them is that if you catch word of a patient having new insurance, you submit the off the same day you catch that. Using that date to leverage, Hey, I submitted it on this day. The patient had to postpone their treatment. I need them in next week, is really helpful. not everything is an emergency, so please don’t expedite everything unless that patient truly needs treatment. we tend to over expedite things the first of the year because we want that determination quickly, but that just backlogs the process further. So be responsible about your expediting. Know that fee schedules and policies could change not just January one, but January 15th, February 1st. So be sure you’re following those, checking all of those for your practice. So there’s, I could go on for hours of all the things that could happen. But really it’s preparing yourself for January one, following your preparations in January and February, and then executing.

Dylan McCabe: That’s so good. the better you can prepare the, less of an intense workload it is, right? So, so I hear you mentioned, you’re mentioning leverage your relationship with manufacturers, check and make sure you’ve got processes in place. because it makes sure that they’re simple, repeatable and followed by all. So, and then making sure that you’ve got even a checklist that you guys provide, which is great. And I think, that’s key to adjusting expectations of what your workload looks like that first quarter. So when we talk about preparing for the end of the year and with all the, multifaceted scenario you’ve got with Christmas and new patients going on, everything like that. what’s, the What’s one key piece of advice? We’ve said a lot, but if you would want our audience to hear one thing, if you had just 60 seconds, one thing on preparing for the end of the year, what would it be?

Elizabeth Johnson: The more prepared you are, the better you will be. But remember, we’re human, right? Something may or may not happen. And so it’s how you address the beforehand and prepare yourself, but also how you’re going to handle if something goes wrong. With a team approach, you’re less likely to have something go wrong, but know that again, you’re a team. So if it does, you fix it as a team.

Dylan McCabe: That’s so good. Yeah. You got to have that atmosphere where you guys can meet, whether it’s once a week or whatever, to identify, discuss and solve issues together. Most people don’t identify, discuss and solve. They just, they just discuss.

Elizabeth Johnson: Yeah,

Dylan McCabe: they don’t knock those problems down together and put them behind them forever. So that’s great. That’s really great advice. Well, what would be your, parting piece of advice for, for our listeners? We’ve talked about, education and equipping. We’ve talked about preparing for the end of the year. and I know you also are passionate about how we can all work together. So what would you like to part with as far as how we can all work together?

Elizabeth Johnson: Sure, absolutely. And it goes with this whole theme we’ve talked about right investing in your staff and your time and making sure you do have time to have a full discussion identifying find solutions is really key. And, there’s a million different nonprofits, we all have our different groups, but we all have overlap right the patient is our number one focus, and I’m sure with we infuse with NICO with the MAPA. We all have that patient centric mindset. So, while we’re different, different pieces and parts of, how this goes, we really are all in it together. So, at the end of the year, at any time of the year, I love that I can sit down with anyone from your team and chat, hey, this is what we have going on. Is there any recommendations you have for us? And really, you guys have such a great footprint with these infusion centers. I love the feedback. I love the team there. And I think we keep the discussion open. I think these organizations, we’ve become phone of friends at this point. if there’s a question, we throw it out on LinkedIn. We leverage our social media platforms to have these discussions. And, I’d love to see more of that. I’d love to see more advocacy together. And I throw that out there because, you These manufacturers, while we’re pushing for their resources, they have these new advocacy roles, and, there’s a few that I’ve worked with that are excellent, and there’s a few that I’ve worked with that I’m not sure they know where they’re going. So how can organizations like yours and mine really get the most out of these relationships, and truly put this advocacy to the test? Because I think, post COVID world, if we ever get there, we’re gonna need some help and I think that’s the way the avenue we should be going.

Dylan McCabe: It’s so good. Well, I know people listening to this are going to want to learn more about the map. So what’s the best way that they can get in touch with you guys?

Elizabeth Johnson: Absolutely. We have a website. W. W dot map dot org. You can contact us through there. And you can personally reach out to me. I’m on LinkedIn, Facebook, Instagram, all the social sites. and so is my team. So we have our own page on LinkedIn, shoot us a message. it’ll come directly to one of us and we’re happy to further the conversation, send you any of the guides that we have, but more so please give us feedback. we are wide open and ready to receive it.

Dylan McCabe: Awesome. Well, Elizabeth Johnson, she’s the president and co founder of NMAPPA. Thank you so much for joining our show today.

Elizabeth Johnson: Thank you so much for having me. This has been fun.

Dylan McCabe: All right. Great interview with Elizabeth Johnson. I love what she said about making sure you’ve got those people in place with a plan to get ahead of the blizzard. I also like what she said about processes, the, even the very checklist that they offer. So I’m sure many of you are interested in that. You can go to their website. All right. Or like she said, you can connect with her on LinkedIn and if you wanna learn more about how we infuse can save you time and money, just head over to we infuse.com. Schedule a free test drive with one of our account executives today. You will be so glad you did. Alright guys, this is Dylan McKay with the We Infuse Podcast and I will catch you in the next episode.

Guest Speaker: President & Co-Founder of the National Association of Medical Access & Patient Advocacy (NAMAPA), Co-CEO at Healthcare Advocate Summit, and CEO at MedicoCX, Elizabeth Johnson is a Licensed Practical Nurse. A public speaker and patient advocate, she focuses on specialty medication access. Elizabeth is also a member of the National Council for Prescription Drug Program (NCPDP) and the American Society of Allergy Nurses.