Care Management and Utilization Review Project Success

Monday, February 11, 2013

OPS recently completed a successful project in a hospital's Care Management (CM) department focusing on Utilization Review (UR) completion by 5pm.  The CM and UR role is vital to the success for the hospital.  It plays a critical role in the reimbursement received from commercial and government payers.  Through the application of the A3 Problem Solving methodology, a team of Care Managers were able to develop a Standardized UR process resulting in a nearly 5 min savings per UR.  That saves 1.8 hours per Care Manager per day.  It also standardizes the clinical content provided to payers.
Additionally, there was a 50% reduction in the morning set-up time which could be up to 1 hour a day per Care Manager.  Other changes resulting from this A3 activity were made organizationally that had a dramatic impact in the CM structure and IT interfaces.  As a result of all these improvements, the goal of 100% completion of UR's by 5pm will be achieved and maintained.

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