A non-profit healthcare organization re-authorized insurance coverage for thousands of patients with a niche team of specialists in order to reduce treatment costs.
SITUATION
Our client, a non-profit healthcare system faced the task of transferring 8,000 active oncology treatment plans from an affiliated medical school provider to their Epic Electronic Health Record (EHR) system. The strategic move was designed to leverage the non-profit's purchasing benefits, allowing access to lower-cost medication for cancer patients. This transition had to be executed within a strict 12-week window to align with contractual agreements with payers, creating a complex logistical challenge. They needed to ensure a seamless transfer without impacting the patient experience and navigate the uncertainties of payer responses. Recognizing the need for specialized expertise, the healthcare provider partnered with Everforth Apex.
Zero Disruption in Patient Care Throughout Re-Authorization
Everforth Apex was responsible for managing all aspects of this project from recruitment to operational execution. Initial steps involved a meticulous assessment of the project scope, followed by the formation of a team comprising of six lead specialists and 54 authorization analysts. This team was selected to match the project's unique demands - possessing deep expertise in Epic's registration and case management workflows and capable of high-volume, high-accuracy work. Each team lead played a pivotal role in maintaining communication flow, ensuring their teams were aligned with daily goals and fully informed on project developments. The authorization analysts were responsible for calling payers and reauthorizing treatment plans for each patient to move to the non-profit provider. Regular stand-up meetings were held to keep all stakeholders, including client representatives, informed of the progress and any emerging challenges.
RESULTS
Through strategic planning and high production execution, Everforth Apex successfully re-authorized insurance coverage for all 8,000 patients within the designated timeframe while staying under budget. The efficient handling of the insurance transfer saved the healthcare provider significant administrative hours and gave patients access to lower cost medications. The project's success was highlighted by the absence of any disruption in patient care. Patients continued their treatments without any noticeable impact on their healthcare experience, seamlessly transitioning under the new system.
