How Tricia Robinson Eliminated 15 Data Silos: A Detailed Case Study of Unified Care Data
Before moving to a unified system, Tricia Robinson’s agency had 15 distinct data silos.
She didn’t even realize she had 15. She thought she had a normal agency. But when she started mapping how information flowed (or didn’t flow) through her systems, she found information broken into 15 separate places where it shouldn’t have been.
This case study breaks down each silo, why it existed, what it cost, and how it disappeared.
How Tricia Robinson Eliminated 15 Data Silos: A Detailed Case Study of Unified Care Data
Silo #1: Caregiver Credentials
- Lived in: Compliance system
- Needed by: Scheduling (to verify credentialed assignments), Billing (to verify compliant billing), EVV (to flag uncredentialed visits)
- Cost of silo: Uncredentialed visits got scheduled and billed. Compliance risk. Claim denials when discovered.
Silo #1: Caregiver Credentials
- Lived in: Care planning system
- Needed by: Scheduling (what to assign), Documentation (what caregivers should do), Billing (what services to bill for)
- Cost of silo: Caregivers documented care that didn’t match plans. Billing didn’t align with actual care orders. Care deviations weren’t caught.
Silo #1: Caregiver Credentials
- Lived in: Scheduling system
- Needed by: Compliance (credential verification for assignments), Billing (what to expect), EVV (actual vs. scheduled comparison), Payroll (hours worked vs. hours scheduled)
- Cost of silo: Schedule changes didn’t propagate. Billing had to manually reconcile. Hours worked never matched hours scheduled.
Silo #1: Caregiver Credentials
- Lived in: EVV system
- Needed by: Scheduling (to verify visit actually happened), Documentation (to cross-check care notes), Billing (to confirm billable hours)
- Cost of silo: EVV data sat in a separate system. Billing coordinator had to manually pull hours from EVV to cross-check against documentation.
Silo #1: Caregiver Credentials
- Lived in: Documentation system
- Needed by: Care coordination (what care was provided), Billing (verify care matches billing), Compliance (audit trail)
- Cost of silo: Care coordinators had to manually check documentation. Billing had to manually verify care was provided. Audit trails were incomplete.
Silo #1: Caregiver Credentials
- Lived in: Billing/Revenue cycle system
- Needed by: Finance (reconciliation), Payroll (hours validation), Compliance (billing audits)
- Cost of silo: Finance had to manually reconcile. Payroll discrepancies took hours to resolve. Billing audits were painful.
Silo #1: Caregiver Credentials
- Lived in: Client/patient management system
- Needed by: Billing (verification of coverage), Care coordination (eligibility questions)
- Cost of silo: Billing coordinator couldn’t see insurance status in real-time. Spent time verifying coverage manually.
Silo #1: Caregiver Credentials
- Lived in: Scheduling system (plus email, text messages, tribal knowledge)
- Needed by: Recruiting (job assignment flexibility), Payroll (contracted hours), Care coordination (scheduling constraints)
- Cost of silo: When caregivers changed availability, scheduler had to manually update (and often didn’t). Offered shifts to unavailable caregivers.
Silo #1: Caregiver Credentials
- Lived in: Learning management system
- Needed by: Recruiting (onboarding checklist), Compliance (qualification verification), Billing (certifications impact billing)
- Cost of silo: Couldn’t verify if required training was complete before assignment. Had to manually check.
Silo #1: Caregiver Credentials
- Lived in: Email, text messages, Slack
- Needed by: Care coordination (decision context), Compliance (audit trail)
- Cost of silo: Critical communication happened outside systems. No audit trail. Critical information was lost.
Silo #1: Caregiver Credentials
- Lived in: Case manager’s email or external system
- Needed by: Scheduling (care coordination), Care coordination (updated requirements), Documentation (context for care)
- Cost of silo: Caregivers didn’t see case manager’s notes. Scheduled care without context. Made care decisions without full information.
Silo #1: Caregiver Credentials
- Lived in: Email, phone calls
- Needed by: Care coordination (family preferences), Documentation (family-provided context), Billing (family-authorized services)
- Cost of silo: Family preferences weren’t documented. Different staff had different conversations with families. Inconsistent information.
Silo #1: Caregiver Credentials
- Lived in: Incident report system (or paper)
- Needed by: Care coordination (pattern identification), Compliance (documentation), Billing (billing implications)
- Cost of silo: Incident information wasn’t tied to client records. Patterns weren’t identified until audit.
Silo #1: Caregiver Credentials
- Lived in: Payroll system
- Needed by: Budget forecasting (labor cost), Billing (service rates), Recruiting (salary offers)
- Cost of silo: Budget forecasting had to manually pull payroll data. Billing rates didn’t match actual costs. Recruiting didn’t know what to offer new hires.
Silo #1: Caregiver Credentials
- Lived in: Manual spreadsheet maintained by compliance coordinator
- Needed by: Scheduling (verification), Recruiting (qualification verification), Billing (compliant billing verification)
- Cost of silo: The spreadsheet was often 2-3 days behind reality. Multiple versions existed (each department had their own). Audit discrepancies occurred.
The Care Quality Impact: Risks Created by Fragmented Data
When Tricia looked at the impact of these 15 silos on care quality, she realized: Fragmentation was directly impacting the care she provided.
Example: Mrs. Patterson’s Care Coordination Failure
Mrs. Patterson had a complex care plan. She was on medication for anxiety, and her daughter specifically asked: “Please note any behavioral changes.”
But this note lived in:
- Daughter’s email (one version)
- Caregiver’s mental note (no documentation)
- Care coordinator’s spreadsheet (if she remembered to enter it)
- NOT in the care plan (silo #2)
- NOT in the documentation system (silo #5)
One day, Mrs. Patterson had elevated anxiety levels. The caregiver documented it (in the documentation system). But the documentation system didn’t reference the daughter’s specific concern. The care coordinator was supposed to flag this—but she was unaware (information was in silos).
Days later, when the daughter asked “Did you notice any behavioral changes?”, the response was vague: “Nothing concerning.” But actually, something was documented. Just not in a way that connected to the daughter’s specific worry.
Risk: Care coordination failed. Family trust deteriorated. Potential safety issue missed.
This wouldn’t have happened with unified data. The daughter’s note would be visible to all caregivers. The documentation would automatically connect to the daughter’s concern. Care coordination would be automatic.
The Compliance Exposure: Audit Risk from Disconnected Records
Tricia had a state audit coming. She was nervous.
When the compliance coordinator pulled her “audit preparation” file, here’s what she found:
Credential Status: Three Different Answers
- Compliance system: Caregiver John is current on CPR (expires 6/15/2025)
- Scheduling system: Caregiver John’s CPR is expired
- Spreadsheet: Caregiver John’s CPR is current
Which is right? The coordinator had to manually investigate. She found that John had renewed in January, the compliance system was updated, but the scheduling system wasn’t updated, and the spreadsheet was overlooked.
Billing & Documentation Discrepancy
- Billing shows: 48 hours billed for Client ABC in February
- Documentation shows: 40 hours documented in February
- Schedule shows: 45 hours scheduled in February
Which is accurate? The coordinator had to manually reconcile. Found that 3 hours weren’t documented (caregiver rushed), 2 hours were documented but not billed (billing oversight), and 2 hours were scheduled but didn’t happen (weather cancellation).
Audit Risk: Discrepancies raise red flags with regulators.
When Tricia moved to a unified system, these discrepancies disappeared:
- One source of truth for credentials (impossible to have three versions)
- One source of truth for care (hours scheduled = hours documented = hours billed)
- One audit trail (complete and immutable)
The Specific Silos Eliminated During Transition
When Tricia implemented the unified system, she systematically eliminated each silo.
Weeks 1-2: Foundation Silos
- Silo #1 (credentials) → Now visible to everyone
- Silo #3 (visit schedule) → Now synchronized with all systems
- Silo #6 (billing records) → Now directly connected to visit data
Weeks 3-4: Care Coordination Silos
- Silo #2 (care plans) → Now visible to caregivers in real-time
- Silo #5 (documentation) → Now connected to care plan
- Silo #10 (communication logs) → Now tracked in system
Weeks 5-6: Operational Silos
- Silo #4 (EVV data) → Now flows automatically to billing
- Silo #7 (insurance info) → Now available to billing coordinator
- Silo #8 (caregiver availability) → Now enforced by system
Weeks 7-8: Compliance Silos
- Silo #9 (training) → Now tracked and visible
- Silo #11 (case manager notes) → Now connected to scheduling
- Silo #13 (incident reports) → Now tied to client records
- Silo #15 (compliance summary) → Now automatic and real-time
Week 9: Integration
- Silo #12 (family communication) → Now integrated
- Silo #14 (pay rates) → Now connected to budget planning
What This Meant for Tricia’s Team
For her compliance coordinator:
“I went from maintaining 15 different lists and checking and rechecking data that should have been one list, to reviewing one unified compliance status. What took 40 hours per week now takes 8.”
For her billing coordinator:
“The biggest change: I’m not reconciling anymore. Billing data matches documentation. Documentation matches EVV. EVV matches what was scheduled. No more detective work. I actually submit claims instead of investigating discrepancies.”
For her scheduling coordinator:
“When I create a schedule, the system knows: credentials, availability, care plan requirements, payroll constraints. I’m not coordinating five different pieces of information across five systems. I’m working in one system that knows everything.”
For her caregivers:
“Everything is in one app. I see my schedule, my clients, their care plans, where to document. No more confusion about where to enter information. No more asking: ‘Is this in the old system or the new system?’ There’s only one system.”
The Financial Impact of Silo Elimination
When silos disappeared, the financial impact was significant:
Direct Savings: $98,000
- Labor reduction: $65,000 (fewer coordination hours needed)
- Reduced errors: $33,000 (fewer denials, fewer compliance issues)
Indirect Benefits: $44,000
- Improved retention: $30,000 (better caregiver experience)
- Faster collections: $14,000 (reduced A/R days)
Total silo elimination impact: $142,000
