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      New At-Risk SOP (Updated 3/25/24)

      This SOP provides the general requirements for Health Prime’s escalation path. The At-Risk process is designed to understand our client’s objectives and expectations at a deeper level, and encourage better collaboration.

      Overview:

      The At-Risk process encompasses the procedures to be followed for client escalations or early warning signs of potential cancellation. Through a central intake stream in HubSpot, the Client Success team members are the main owners of reporting, documenting, and preparing countermeasures based on the type of client escalation to ultimately try to Save the client.

      If the client cannot be Saved and would still like to Cancel services, this should be tracked and documented via the At-Risk ticket process.

      Benefits of the At-Risk process:

      • Full transparency to client escalations via a central intake stream maintained by the Client Success team.
      • Early warning triggers to create action plans with countermeasures to attempt to Save the client.
      • Standardized data to populate Executive dashboards to make informed decisions.

      CLIENT STATUS DEFINITIONS

      Onboarding

      Client is currently in process of being onboarded by the Client Implementation team.

      Active

      Normal status of clients with active HPI services.

      At-Risk

      Status of a client that becomes At-Risk via the At-Risk ticket process.

      Monitor

      Status of a client that has been Saved vis the At-Risk ticket process. The client resides in this status for 30 days to ensure that corrective actions are consistent, and the client is satisfied with process improvements. Client status will revert to Active on day 31.

      Cancellation In Progress

      Status of the client that is marked as Not Saved and the cancellation date is in the future.

      Cancelled

      Status of the client moves to Cancelled once the RCM Cancellation Date has passed.

      Inactive

      Not for use by the Client Success team.

      ATTRITION TYPES & REASONS

      The following table outlines the standard set of Attrition Types and the applicable Attrition Reason(s) for each situation along with defining Controllable vs. Uncontrollable attrition factors.

      Attrition Type Attrition Reason Controllable? Examples
      Breach of Contract  Client Unprofessional No Unprofessional behavior
      Healthcare Non-Compliant Not following protocols
      Non-Payment Over 2 months overdue invoices
      Non-Responsive Unable to make contact, no charges being sent, tasks not worked, etc.
      Client Performance Lack of Client Collaboration/Support/Data No Client did not provide HPI with data/access/resources needed to perform
      Client Reason Billing taken in-house Yes Client has decided to take billing in-house (not due to affordability, see "monthly min.")
      Not Satisfied with PM Billing Software No Client is giving feedback on software (limitations) or has stated they are looking at/considering other software
      Politically driven External uncontrollable factors - not performance or relationship related
      Practice Closing/Deceased/Retired  
      Pricing/Rate Increase Yes Pricing request/expectations below a reasonable profit margin
      Sold/Acquired No  
      Unreasonable Expectations Client's expectations are unrealistic based on contract or business unit structure. For example, client wants smaller billing company, frequent in-person meetings, out of scope reporting needs.
      Monthly minimum Yes Client could not carry the monthly minimum
      HPI Performance A/R follow-up Yes  
      Billing (Charges and Claims)  
      Coding Audit issues
      Credentialing Credentialing errors, lack of follow-up, ineffective communication
      CS turnover Frequent changes in assigned client contact due to attrition, realignment, acquisitions, promotions.
      Ops turnover Frequent ops staff changes
      Patient Financial Services Negative feedback
      Payment Posting I.e. Bank reconciliation issues, patient balances, etc.
      Relationship Management Relationship Management
      HPI Reason Discontinuation of services/products No HPI is intentionally terminating, due to no longer providing services/products contracted

      Attrition factors (Controllable vs. Uncontrollable) & Attrition Types (as listed above for each Attrition Reason) are automatically populated based on the Attrition Reason selected when entering the At-Risk ticket.

      Cancellation Approval will also automatically populate based on whether the client is saved or not. 

      IMPORTANT INFORMATION:

      PLEASE FOLLOW THE STEPS BELOW IN ORDER TO ENSURE PROPER WORKFLOW IS ENGAGED.

      STEP 1: SUBMITTING AN AT-RISK TICKET

      1. Login to HubSpot >> https://app.hubspot.com/login.
      2. Search and select the Company record for the client that is At-Risk.
      3. Click +Add from the Ticket section on the right side of the screen.

      4. Inside the panel to Create NEW ticket, type or select the following information:
        1. (* indicates a required property)

      Setting Name

      Value

      Ticket Name*

      At-Risk – BU - Company Name here

      I.e. At-Risk - OGold - ABC Practice

      Pipeline*

      Select At-Risk Queue

      Ticket Status*

      Default to Open

      Ticket Type*

      At-Risk
      Ticket Owner Defaults to your name

      Priority

      Associate Ticket with Contact  Select the appropriate contact person for the practice. (RISK-See association best practices)​
      Associate Ticket with Company Ensure that the correct Company/ Client Name is selected. (RISK-See association best practices)​
      Add Timeline (Contact/ Company) Optional (NOT Recommended)

      5. Click Create

      RISK WARNING:  Contact and Company Associations MUST be reviewed and adjusted as needed PRIOR to adding / saving the ATTRITION REASON. 

      • Contact: please ensure that the appropriate contact(s) are associated to your ticket (Note: a contact associated to other company records WILL (via API) associate BOTH companies they are associated with.  BE VERY CAREFUL AFTER ASSOCIATION OF A CONTACT. IT IS STRONGLY RECOMMENDED THAT YOU DOUBLE. EVEN TRIPLE REVIEW YOUR COMPANY ASSOCIATIONS BEFORE YOU ADD & SAVE THE ATTRITION TYPE. 
      • Company:  you must ALSO ensure that ONLY the intended Company records have been associated to your At-Risk ticket.

        Once the new ticket is created, begin to update the following properties within your new ticket. 

      Setting Name

      Value

      Ticket Description*

      Detailed reason for the client escalation in an SBAR format.

      ·        S – Situation

      ·        B – Background

      ·        A – Assessment

      ·        R - Recommendations

      Attrition Reason*

      Select from the drop down the reason that aligns with the type from the table above.

      6.   Click SAVE.

      CLICKING SAVE ABOVE, AFTER ADDING THE ATTRITION REASON, WILL ENROLL YOUR AT-RISK TICKET IN THE HUBSPOT WORKFLOW. 

      **ANY CHANGES TO THIS REASON MAY REQUIRE A SUPPORT TICKET**

      STEP 2: Continue to populate your AT-RISK TICKET

      1. In the body (middle section) of the ticket, create the At-Risk notes by typing #At-Risk Notes to pull up the note template. Click At-Risk Notes.
        1. Most of the At-Risk Notes are designed to pull data automatically from the Company record. There are free text lines that will need to be filled in by you.
        2. Click Save Note once you are done adding relevant data.
      2. Enter the Escalation Source, the options are:
        1. Client
        2. CS Team
        3. Operations
      3. To ensure the At-Risk ticket has been properly submitted, refresh the screen (may need to refresh a few times) and the following should populate for you:
        1. Attrition Type (populates as long as the attrition type is valid.
        2. Controllable (Yes or No) will automatically populate based on the attrition reason/ type and
        3. on the company record, the "Client Status" property should reflect "At-Risk"
      4. Attach or log any additional communications pertaining to this escalation if it isn’t already documented in any Activity (i.e., email notice of cancellation, WOR logged call where client mentioned unhappiness, etc.)

      If you have any questions or issues submitting an At-Risk Ticket please work directly with your management team. 

      Step 3: Follow the At-Risk Action Process


      Utilize the applicable action(s) assigned to the Attrition Type and Attrition Reason in conjunction with weekly schedule for managing At-Risk clients to bring resolution to the client escalation. 

      * If you are unsure of what the applicable action(s) are, please reach out to your leadership team for assistance. 

      Step 4: Resolution to At-Risk Ticket – Client Saved or Not Saved

      Client Saved

      1. CS Manager sets the Customer Saved property to Yes. Click SAVE

      2. The Client Status property on the Company record will be set to Monitor. It will remain in this state for 30 days to ensure that any new processes implemented to deescalate the client are working and the client is satisfied with the resolution. After the 30 days of Monitoring, the Client Status will move back to Active.

      3. The At-Risk ticket is closed.

      WARNING: If your clients status is in 'Monitor' and the client becomes at-risk again, since the ticket was already closed, you will need to OPEN A NEW AT-RISK TICKET.

      Client Not Saved

      1. CS Manager sets the Customer Saved property to No. Click SAVE

        • CSC Action Items:

          1. Upload the client’s written notice of cancellation.

        • The CS Manager Action Items:

          1. Create ETF (Early Termination Fee) Note using the Snippet #ETF and provide details requested.

          2. Set the RCM Cancellation Date in the At-Risk ticket. Click SAVE

      2. The At-Risk ticket is automatically closed when the CS Manager enters the RCM Cancellation Date.

      3. Through automation the Client Status will be changed to Cancellation in Progress.

      4. When the RCM Cancellation Date occurs, the Client Status will automatically be updated to Cancelled.

      Special Cancellation Requirements for Tebra Clients

      1. The CSC is to send the email “PMB Cancellation Info for Customer” to the client contact once the cancellation has been approved.

      2. The CSC is to upload all final reports into Documents and remove the CBR from the Tebra PM on the RCM Cancellation Date or on the last business day if the RCM Cancellation Date falls on a weekend or holiday.  Here is the list of final reports

      3. The CS Manager must send notification to Tebra about the client’s cancellation. Use the applicable email template depending on the cancellation type, Cancellation Notification to Tebra-Full Cancellation or Cancellation Notification to Tebra-Downgrade/Transfer of Ownership.

      Notice to Tebra should not be sent more than 90 days prior to, but at least 3 business days prior to the RCM Cancellation Date

      Change to RCM Cancellation Date:

      When a client notifies the CSC or CS Manager that they would like to extend their cancellation date, the CS Manager will need to:

      1. Submit a Hubspot Support Ticket to request that the RCM Cancellation Date be changed/ updated in the Company record. (see blue box below)
      2. Locate & update the At-Risk Ticket related to this cancellation, with the new RCM Cancellation Date.
      3. Place a Note or other Activity log in the At-Risk ticket documenting the change to the customers cancellation date.

      Rescinded Cancellations:

      When a client notifies the CSC or CS Manager that they would like to rescind their cancellation, and the At-Risk ticket has been fully processed with RCM Cancellation date, Customer saved= NO, etc. You must enlist the assistance of the Hubspot administration team. 

      1. Submit a Hubspot Support Ticket to request that the Client Status is returned to Active (see blue box below)

      Help is here when you need it!

      If your ticket or company is not processing properly for the At-Risk workflow, please submit a PrimeSupport Hubspot Support ticket for help! 

      • If something is not working please select "Report an Issue".
      • Requesting a new workflow, edit to an existing workflow or removal of a workflow please select "Workflows & Automations".
      • If you cannot access your Hubspot account please select "User Access".
      • Need help with a new report or dashboard? Please select "Reports & Dashboards".
      • If you are requesting a new or change to an existing property or object in Hubspot, please select "Properties & Objects".

      Thank you!