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Points of Light 2023 Case Study 25
Streamlining Prior Authorizations for Cardiovascular Patients via a Utilization Management Portal
Author
Boyd Stewart
Author
Aurene Wilford
Diagnosing patients that present with cardiovascular symptoms can be a lengthy process, involving multiple providers and progressive testing that may end up being duplicative or unnecessary. This process is costly and delays patient access to treatment. To address these issues, the collaborators in this case study adopted a utilization management portal that helps providers identify the correct evidence-based care paths and streamlines the prior authorization process for cardiovascular testing and treatments. Achieved outcomes include fewer denials, fewer peer-to-peer reviews, and decreased turnaround times for authorization decisions.
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Key Findings:
- Executive Summary
- The Collaborators
- Points of Friction—Challenges to Be Solved
- Action Plan—How the Collaborators Worked Together to Reduce Friction
- Points of Light—Outcomes Achieved through Collaboration
- Lessons Learned—What Best Practices Can Other Organizations Replicate?
- What's Next?—Vision for the Future
Writer
Elizabeth Pew
Designer
Jess Wallace-Simpson
Project Manager
Joel Sanchez
This material is copyrighted. Any organization gaining unauthorized access to this report will be liable to compensate KLAS for the full retail price. Please see the KLAS DATA USE POLICY for information regarding use of this report. © 2024 KLAS Research, LLC. All Rights Reserved. NOTE: Performance scores may change significantly when including newly interviewed provider organizations, especially when added to a smaller sample size like in emerging markets with a small number of live clients. The findings presented are not meant to be conclusive data for an entire client base.