Photo: Project leaders, from left, include John Csencsits, Clinical Application Support Analyst – Care Management; Marjorie Polis, Manager, IT Operations/Applications; Daelene Long, Director, Clinical Operations and Care Management; and Linda Stanton, Manager, Care Coordination – Utilization Management.
The LVHN Guldin Award for Efficiency and Innovation in the Nonclinical Workplace was presented to the Populytics Care Management and Information Technology teams in January. Team members and leaders in this group effort were recognized for implementing an alternative electronic portal method, integrated with the current workflow system, to receive and process clinical pre-authorizations for LVHN Health Plan members and dependents.
How the “Connect Portal” came about
This past year, the Populytics Care Management team upgraded its clinical workflow system and learned that a provider-facing portal could be implemented to increase efficiency and customer service. After evaluating the opportunity, leadership proceeded with the implementation and the Clinical and IT teams worked collaboratively for over six months to prepare for launch; working with Populytics’ clinical portal vendor on a seamless internal integration to existing tools and training Populytics colleagues. Then in August 2019, the Populytics Care Management team began recruiting and training LVHN/LVPG provider practices and departments to use the new electronic portal to handle LVHN Health Plan member pre-authorization requests for clinical services.
Since the launch in November, more than 5,000 pre-authorization requests were received through the Connect Portal. To put its utility into perspective, the Populytics Care Management processes over 28,000 pre-authorizations a year for LVHN colleagues and dependents. Pre-authorization requests for services requiring review for medical necessity, such as MRIs, physical therapy, specialty drugs, durable medical equipment, and other treatments, are sent to them from physician/provider practices. In the past, these pre-authorization requests were restricted to paper or e-fax, or sent through a non-integrated provider portal. The ensuing process to then enter those into the clinical review system was tedious and time consuming, with many repetitions that required several submissions.
A continuing process
Implementation of this portal system also required physician practices to change their method of submitting pre-authorizations to Populytics. Under the leadership of Linda Stanton and John Csencsits, 12 large LVHN practices and departments, with more than 100 colleagues, were trained to use the Connect Portal. John and Linda’s training and support to these practices has ensured a consistently steady roll-out and sustained increase in portal use since implementation, which ultimately means more timely responses as well as faster approval and scheduling of patient care.