Prior authorization processes can contribute to delays in patient care, potentially leading to treatment abandonment or serious adverse events. Thibodaux Regional Health System (Thibodaux Regional) encountered lengthy prior authorization processes for magnetic resonance imaging (MRI), hindering its ability to provide timely care, and prompting patients to seek imaging services outside their community. By establishing a cross-functional improvement team, leveraging an improvement framework, and using data and analytics insights from the Health Catalyst® Data Platform, Thibodaux Regional optimized imaging workflows, resulting in reduced MRI waiting times, increased MRI volume, and improved patient satisfaction.
More than 90 percent of physicians report that prior authorization processes cause patient care delays, 82 percent state that it sometimes leads to treatment abandonment, and 29 percent report that it has caused a serious adverse event for at least one of the patients they’ve cared for.1 Recognizing these challenges, Thibodaux Regional sought to reduce authorization delays and improve patient care.
Despite achieving high-quality outcomes, Thibodaux Regional faced challenges related to payer processes, threatening its ability to achieve its strategic vision. Lengthy prior authorization processes impeded its ability to provide timely care, and some payers attempted to dictate treatment locations, prompting patients to seek imaging services outside their community. The organization needed to ensure patients could access high-quality, timely care within their community and prevent patient outmigration to surrounding organizations.
The organization established a cross-functional improvement team and applied the DMAIC (define, measure, analyze, improve, control) improvement framework and data and analytics insights from the Health Catalyst® Data Platform to guide and transform its imaging processes. Strategic priorities were defined and clarified for all team members, emphasizing the need to retain patients, ensure timely access to magnetic resonance imaging (MRI), standardize processes, and optimize financial performance.
Using real-time data from its data platform, Thibodaux Regional quantified current-state performance, including the impact on patients and the financial impact, and identified variability in imaging and ambulatory workflows. Improvement teams analyzed performance and identified critical actions to reduce payer-driven leakage, enhance efficiency, and enhance patient experience.
To improve performance, the organization removed insurance constraints and redesigned imaging workflows. Thibodaux Regional was confident it was providing patients with appropriate, quality care and recognized that MRI prior-authorization processes often delayed care and sometimes led patients to obtain needed exams elsewhere. Rather than waiting for pre-authorization to be completed before scheduling patients for MRIs, the organization began submitting pre-authorization data and immediately scheduling patients for the MRI, efficiently providing them with the needed exam. The organization also aligned staffing and equipment utilization, eliminating the need for contract labor.
To control and sustain the improved processes, Thibodaux Regional defined acceptable waiting times and used data and analytics to continuously monitor performance. The organization created an early warning system for undesirable changes in performance. It delivers performance reports from the data platform to key stakeholders. If MRI waiting times exceed the organizationally defined expectation, an alert is sent to the process manager, who then implements pre-defined interventions to improve performance.
Thibodaux Regional’s data-driven improvement efforts are delivering the desired results. In just one year, the organization achieved:
“We began with the end in mind—high-quality patient care, an excellent patient experience, and financial stability—and used data and analytics to challenge old assumptions."
- Greg Stock, MHA, CEO, Thibodaux Regional Health System
Thibodaux Regional plans to continue using analytics and its improvement framework to enhance ambulatory access, care quality, financial performance, and community well-being.
