Case Study: Apria Healthcare Taps LCMS

Apria Healthcare taps its learning content management system (LCMS) to rapidly create, reuse, and track training in order to meet the challenges creat


Apria Healthcare Taps LCMS

Apria Healthcare taps its learning content management system (LCMS) to rapidly create, reuse, and track training in order to meet the challenges created by a new bidding structure mandated by the Centers for Medicare & Medicaid Services.

Lake Forest, California-based Apria Healthcare provides customers with home healthcare products and services, including respiratory therapy, diabetic supplies, medications, and home medical equipment services. 

The company employs approximately 11,000 healthcare professionals in more than 500 branch offices across the United States, serving over one million patients annually. Each year, healthcare companies such as Apria receive payments from the Centers for Medicare & Medicaid Services—part of the U.S. federal government—for supplying items like wheelchairs, oxygen equipment, and respiratory services to millions of Medicare beneficiaries. 

Apria continuously trains its employees, ranging from managers and administrative staff to nurse clinicians and pharmacists, about the company’s products and services, as well as an array of government regulations.


In 2008, the U.S. Congress directed the Centers for Medicare & Medicaid Services (CMS) to put in place a new competitive bidding structure for physicians and durable medical equipment providers, such as Apria. 

The new structure was to begin on July 1, 2008, as a pilot in selected metropolitan areas. “The new CMS structure stated that durable medical equipment providers would have to bid for the right to supply products to Medicare beneficiaries,” says Gaylene Galliford, manager for Training, Design & Development at Apria Healthcare. “Whoever won the bid for each product would earn the right to supply those healthcare items.”

This new structure promised some complexity for Apria’s sales, marketing, and customer service teams. The company had long billed itself as a one-stop shop for home healthcare products and services. But the new regulations meant Apria couldn’t always market itself as a single source for Medicare beneficiaries’ needs.

Galliford’s team had to put together a training program for 500 Apria employees in 54 branches who worked in the metropolitan areas that CMS selected in the first round of bidding. The program would teach Apria employees the new procedures for selling selected products and services as well as helping customers. Apria decided it had to create content for employees, based on role and market.

According to Galliford, the training content was complex and nuanced. Sales staff, customer service representatives, and logistics personnel would each need to focus on different ramifications of the new bidding structure. 

Apria faced a training challenge in which it needed to rapidly disseminate a core set of training, yet personalize the training to meet the needs of employees with different jobs. Because Congress mandated the new bidding structure, Apria would also have to prove its workforce was complying. And that meant reporting on each employee’s level of proficiency once they had been trained.

CMS began awarding bids to providers of home healthcare products in the middle of June 2008. Apria had to work quickly to meet the July 1 CMS rollout and highlight the products and services that had received a winning bid.


“We turned to our learning content management system,” adds Galliford. Apria’s learning content management system (LCMS), made by OutStart, enabled rapid authoring and reuse of content, while supporting assessments and personalized training.

“Our regulatory affairs group asked our instructional designers to make last-minute changes to 20 pages of course content. We could’ve never accomplished that by our deadline without an LCMS,” says Galliford. 

“We had to not only create a course instructing all employees on the new regulations, but also teach disparate groups of workers about the nuances affecting their specific roles. We used the LCMS to build two modules for our course, which we then reused for all groups; the last modules we built were specific to each person’s job.”

Apria delivered its first online CMS course on June 29, in time to train employees for the July 1 rollout of the CMS program. Augmenting the online training were conference calls in which Apria’s trainers reinforced messages with employees. To ensure all employees were grasping the new regulations, Apria used its LCMS to embed a test at the end of each module. 

The assessment required employees to determine what products or services qualified for Medicare’s new bidding structure and answer potential questions from customers. With the LCMS, Apria could see which employees within a given location were not only completing the training but also how well they grasped the material.

Apria’s LCMS also includes a content model for employers to develop and reuse any learning object no matter where it was created. The software provides training departments with an advanced taxonomy and metadata tags to easily categorize and retrieve content, which simplifies reuse and reduces maintenance of the bits and bytes that make up training. These features made it easy for Apria to take content for one audience and reuse it for another.

While Apria trained its employees, a lobbying effort by durable medical equipment providers and physicians regarding the new bidding structure convinced Congress to delay the implementation of the CMS program for 18 months. 

So, Apria had to roll out another training program in early July to advise its employees about the delay by Congress and the details of an intermediate plan to be followed until the new CMS launch date. “The LCMS helped us mirror the frequent changes related to the CMS competitive bidding program,” says Galliford. “It’s a testament to the LCMS’s power that we could create and reuse content easily and get that information to employees quickly.”


In all, Apria developed five courses in two weeks for the CMS competitive bidding process. Apria’s Training, Design & Development team delivered the first of the five online courses two days prior to the Centers for Medicare & Medicaid Services’ July 1, 2008, deadline. 

Within 24 hours, approximately 500 employees scattered across 54 branches had completed the course. Apria’s training team says it saved more than 50 hours of design work because they were able to reuse modules from the initial CMS course for follow-on content. “The assessment capabilities of the LCMS verified that staff in each metropolitan area had taken and, most importantly, understood our training,” says Galliford.

Without its LCMS, Apria says it probably would have conducted the CMS training via a conference call with slides. Instead, Apria used its LCMS to create interactive training filled with tests that reinforced concepts, which made a complex issue easier for all employees to understand. 

And the LCMS enabled employees to take training where and when it suited them. “Our LCMS includes internal tracking and reporting that we can easily generate any time,” says Galliford. “These customized reporting capabilities suit our needs as well as compliance requirements, so we’re never in doubt as to what training has been delivered and who’s taken it.”

For example, The Joint Commission (formerly known as The Joint Commission on the Accreditation of Healthcare Organizations) audits companies like Apria to assess if these employers are following proper industry procedures and training accurately. If The Joint Commission finds an employer has failed to comply with regulations, that organization’s accreditation can be taken away. Adds Galliford, “Our LCMS plays a critical part in accounting for training.”

Keyword : LCMS, learning content management system