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When the COVID-19 pandemic began, Atlantic Well being System, like different healthcare suppliers, discovered itself below monumental stress. Along with coping with sufferers struggling the consequences of a brand new virus, healthcare suppliers needed to deal with new care protocols, staffing points, and provides shortages spurred by the pandemic, all of which positioned further strain on any current friction in healthcare administration processes.
“The pandemic and the ageing inhabitants and rising inhabitants actually put very excessive stress on each healthcare system, and Atlantic Well being was no exception,” says Sunil Dadlani, chief info and digital officer and chief cybersecurity officer on the New Jersey-based nonprofit healthcare community. “You mix that with workforce shortages, provide chain shortages, and plenty of different issues which can be happening.”
Atlantic Well being serves a inhabitants of 6.2 million folks, with greater than 400 websites of care, together with six hospitals, and because the group struggled with these points, it rapidly grew to become obvious that insurance coverage authorization for imaging and radiology providers — a foundational diagnostic step earlier than virtually any care can start — was a bottleneck. When care is time-sensitive, any delays can have an effect on affected person outcomes.
Scheduling and receiving authorization for healthcare providers has historically been a extremely advanced and handbook course of. Every of the greater than 100 radiology practices throughout Atlantic Well being System was accountable for its personal authorization requests, which required vital funding of time and a spotlight to administrative duties.
“Our sufferers come from completely different backgrounds, and so they have completely different payors. Every payor has its personal codecs, its personal necessities, its personal processes,” Dadlani says. “With the rising quantity of radiology, it created a way of urgency, as a result of we have been seeing the next variety of denials in pre-authorization. We noticed the next quantity of further documentation that was wanted for pre-authorization.”
To handle these challenges, Atlantic Well being System undertook a undertaking it known as Prior Authorization Clever Automation, which has earned it a CIO 100 Award in IT Excellence.
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