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Points of Light 2025 Case Study 3
Digitally Transforming the Clinical Review Process Between Payer & Healthcare Organizations
Author
Boyd Stewart
Author
Aurene Wilford
The healthcare organization in this case study was manually submitting clinical information for concurrent review to the payer. This inefficient process often prevented the payer from receiving needed information in a timely manner to determine medical necessity. To help automate this process, the stakeholders partnered with Epic to implement Payer Platform at the healthcare organization. By using this solution, the healthcare organization can send needed information to the payer in near real time, helping to reduce the administrative burden and improve patients’ access to care.
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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
Natalie Hopkins
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. © 2025 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.